Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Andre Ignee; Christian Jenssen; Paolo G. Arcidiacono; Michael Hocke; Kathleen Möller; Adrian Saftoiu; Uwe Will; Pietro Fusaroli; Julio Iglesias-Garcia; Ryan Ponnudurai; Maria C. Petrone; Barbara Braden; Eike Burmester; Yi Dong; Nathan S. Atkinson; Christoph F. Dietrich

doi:10.1055/a-0588-4941

Endoscopy, Table of Contents

Endoscopy 2018; 50(11): 1071-1079
DOI: 10.1055/a-0588-4941

Original article

Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Andre Ignee

¹Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Germany

,

Christian Jenssen

²Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany

,

Paolo G. Arcidiacono

³Pancreato-Biliary Endoscopy and Endosonography Division, Vita Salute San Raffaele University, Milan, Italy

,

Michael Hocke

⁴Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany

,

Kathleen Möller

⁵Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany

,

Adrian Saftoiu

⁶Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania

,

Uwe Will

⁷SRH Wald Klinikum Gera, Germany

,

Pietro Fusaroli

⁸Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna, Hospital of Imola, Italy

,

Julio Iglesias-Garcia

⁹Gastroenterology and Hepatology Department, University Hospital, Santiago de Compostela, Spain

,

Ryan Ponnudurai

¹⁰Division of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia

,

Maria C. Petrone

³Pancreato-Biliary Endoscopy and Endosonography Division, Vita Salute San Raffaele University, Milan, Italy

,

Barbara Braden

¹¹Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

,

Eike Burmester

¹²Medical Department I, Sana Hospital Lübeck, Germany

,

Yi Dong

¹³Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China

,

Nathan S. Atkinson

¹¹Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

,

Christoph F. Dietrich

¹Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Germany

¹⁴Ultrasound Department of the First Affiliated Hospital of Zhengzhou, Zhengzhou University, China

› Author Affiliations

Abstract

Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting.

Methods Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection.

Results 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of lesions were stiffer than the surrounding pancreatic parenchyma (stiff lesions) and 50 % were less stiff or of similar stiffness (soft lesions). High stiffness of the lesion had a sensitivity of 84 % (95 % confidence interval 73 % – 91 %), specificity of 67 % (58 % – 74 %), positive predictive value (PPV) of 56 % (50 % – 62 %), and negative predictive value (NPV) of 89 % (83 % – 93 %) for the diagnosis of malignancy. For the diagnosis of pancreatic ductal adenocarcinoma, the sensitivity, specificity, PPV, and NPV were 96 % (87 % – 100 %), 64 % (56 % – 71 %), 45 % (40 % – 50 %), and 98 % (93 % – 100 %), respectively.

Conclusions In patients with small solid pancreatic lesions, EUS elastography can rule out malignancy with a high level of certainty if the lesion appears soft. A stiff lesion can be either benign or malignant.

Full Text

References

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