Endoscopy 2010; 42(7): 564-570
DOI: 10.1055/s-0030-1255537
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study

B.  Napoleon1 , 2 , M.  V.  Alvarez-Sanchez1 , 2 , R.  Gincoul2 , B.  Pujol1 , C.  Lefort1 , 2 , V.  Lepilliez2 , M.  Labadie3 , J.  C.  Souquet2 , P.  E.  Queneau2 , J.  Y.  Scoazec4 , J.  A.  Chayvialle2 , T.  Ponchon2
  • 1Department of Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
  • 2Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France
  • 3Cabinet d’anatomopathologie, 41, Allée des Cyprès, Limonest, France
  • 4Department of Pathology, Hôpital Edouard Herriot, Lyon, France
Further Information

Publication History

submitted 02 September 2009

accepted after revision 09 March 2010

Publication Date:
30 June 2010 (online)

Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope.

Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months.

Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS.

Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.

References

B. Napoleon MD

Department of Gastroenterology
Hôpital Privé Jean Mermoz

55 avenue Jean Mermoz
69008 Lyon
France

Fax: +33-478-742655

Email: dr.napoleon@wanadoo.fr