Endoscopy 2011; 43(7): 596-603
DOI: 10.1055/s-0030-1256314
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study

A.  Săftoiu1 , 2 , P.  Vilmann2 , F.  Gorunescu3 , J.  Janssen4 , M.  Hocke5 , M.  Larsen6 , J.  Iglesias-Garcia7 , P.  Arcidiacono8 , U.  Will9 , M.  Giovannini10 , C.  Dietrich11 , R.  Havre12 , C.  Gheorghe13 , C.  McKay14 , D.  I.  Gheonea1 , T.  Ciurea1 , on behalf of the European EUS Elastography Multicentric Study Group
  • 1Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
  • 2Department of Surgical Gastroenterology, Gentofte and Herlev Hospital, University of Copenhagen, Denmark
  • 3Biostatistics and Computer Science, University of Medicine and Pharmacy, Craiova, Romania
  • 4Helios Klinikum, University of Witten/Herdecke, Wuppertal, Germany
  • 5Department of Internal Medicine II, Hospital Meiningen, Germany
  • 6Center for Surgical Ultrasound, Department of Surgery, Odense University Hospital, Odense, Denmark
  • 7Gastroenterology, University Hospital, Santiago de Compostela, Spain
  • 8Gastroenterology and Gastrointestinal Endoscopy Unit, Vita Salute San Raffaele University, Milan, Italy
  • 9Gastroenterology, SRH Wald-Klinikum, Gera, Germany
  • 10Endoscopic Unit, Paoli-Calmettes Institut, Marseilles, France
  • 11Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany
  • 12Institute of Medicine, University of Bergen and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
  • 13Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest Romania
  • 14Hepatobiliary Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Further Information

Publication History

submitted 2 August 2010

accepted after revision 21 December 2010

Publication Date:
24 March 2011 (online)

Background and study aims: Endoscopic ultrasound (EUS) elastography represents a new imaging procedure that might characterize the differences of hardness and strain between diseased tissue and normal tissue. The aim of this study was to assess the efficiency of EUS elastography for the differentiation of focal masses in chronic pancreatitis and pancreatic cancer.

Patients and methods: The study group comprised 258 patients with focal pancreatic masses included prospectively at 13 participating centers. Qualitative analysis of the diagnoses made by two expert doctors using all recorded video clips was performed in order to test the interobserver variability. A post-processing software analysis was used to examine the EUS elastography videos by calculating average-hue histograms of individual elastography images. The quantitative information was used to calculate intra-observer variability and the accuracy of the method.

Results: Qualitative analysis of the recorded videos revealed a kappa value of 0.72. Intra-observer variability analysis revealed that the single measure intraclass correlation ranged between 0.86 and 0.94. The average-hue histogram analysis of the data indicated a sensitivity of 93.4 %, a specificity of 66.0 %, a positive predictive value of 92.5 %, a negative predictive value of 68.9 %, and an overall accuracy of 85.4 %, based on a cut-off value of 175. Area under the receiver operating characteristic curve (AUROC) was 0.854 (P < 0.0001) with a confidence interval of 0.804 – 0.894.

Conclusion: The value of quantitative analysis of EUS elastography recordings was proven by good reproducibility of the videos, as well as good parameters of the AUROC analysis. (Clinical Trials.gov identifier: CT00909103).


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A. SăftoiuMD, PhD 

Research Center of Gastroenterology and Hepatology
University of Medicine and Pharmacy Craiova Romania

Str. Măcinului nr. 1
Dolj, 200640

Fax: +40-251-593077

Email: adry@umfcv.ro or adriansaftoiu@aim.com