The use of quantitative contrast-enhanced endoscopic ultrasound in the evaluation of pancreatic neuroendocrine tumors: can we move from quality to quantity? A proof-of-concept study

Aims Contrast-enhanced EUS (CE-EUS) is a helpful tool for the diagnosis of pancreatic focal lesions, as pancreatic cancer (PC) and pancreatic neuroendocrine tumor (pNEN). Contrast enhancement is usually assessed qualitatively by the endosonographer. Dedicated software has been developed to obtain an unbiased quantitative assessment using perfusion parameters. We evaluated quantitatively the enhancement of pNENs and PC at CE-EUS.

Methods Seventy-three patients (51 PC and 22 pNEN cytologically diagnosed), who underwent CE-EUS in our hospital were consecutively included. Quantitative analysis of tumor vascularization was performed with a commercially available software (Vuebox, Bracco). Time-intensity-curve (TIC) were created and several parameters were evaluated including the average contrast signal intensity (MeanLin), peak enhancement (PE), time to peak (TTP), mean transit time (mTT), Wash-in Area Under the Curve (WiAUC), Wash-in Perfusion Index (WiPI), Wash-out Area Under the Curve (WoAUC).Univariate and multivariate analyses with patient- and tumor-level variables were conducted

Results Univariate analysis showed that several TIC parameters could significantly distinguish pNENs from PCs (sensitivity/specificity WiAUC 81.8/75.5%, PE 72.7/92.2%, WiPI 72.7/92.2%). At univariate analysis mTT was associated with the diameter of the pNEN (p<0.001). Even if not statistically significant, a trend for an association between TIC and pNEN aggressiveness was observed

Conclusions Quantitative enhancement evaluation in CE-EUS for pNEN could accurately predict the diagnosis of pNEN respect to PC

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023