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Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study
BACKGROUND AND OBJECTIVES: Endoscopic ultrasound (EUS) elastography is a noninvasive ultrasound technique that measures the stiffness of tissues. Both a qualitative score and a quantitative method (strain ratio [SR]) can be used to study the hardness of solid pancreatic lesions (SPLs). This single-c...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731368/ http://dx.doi.org/10.4103/2303-9027.218430 |
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author | Carrara, Silvia Auriemma, Francesco Di Leo, Milena Rahal, Daoud Preatoni, Paoletta Correale, Loredana Anderloni, Andrea Repici, Alessandro |
author_facet | Carrara, Silvia Auriemma, Francesco Di Leo, Milena Rahal, Daoud Preatoni, Paoletta Correale, Loredana Anderloni, Andrea Repici, Alessandro |
author_sort | Carrara, Silvia |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: Endoscopic ultrasound (EUS) elastography is a noninvasive ultrasound technique that measures the stiffness of tissues. Both a qualitative score and a quantitative method (strain ratio [SR]) can be used to study the hardness of solid pancreatic lesions (SPLs). This single-center prospective cohort study aimed to evaluate the efficacy of the combination of EUS elastography and SR for the diagnosis of SPL using the elastography software on the new Olympus echo-processor EU-ME2. METHODS: Two different areas were selected: area A included the tumor; area B was placed in a soft peri-tumoral normal (parenchymal SR [pSR]) and in the gastrointestinal wall (wall SR [wSR]). The quantitative score of elastography was calculated by the SR method (area B/area A). Elasticity measurements were performed 3 times in each procedure. Means of pSR and of wSR were calculated and used as final results for each patient. Final diagnosis was made on the basis of EUS-guided fine needle aspiration, surgical specimens, or follow-up of at least 6 months. RESULTS: Study population included 100 patients and a total of 102 SPLs. Mean lesion (standard deviation) size was 27.1 mm (12.4). The final diagnosis classified SPL into adenocarcinoma (ADC, n = 69) or benign lesions (n = 33). Benign lesion group included 19 neuroendocrine tumors. ROC analysis identified a cutoff of SR of 9.1 as the best value for the detection of malignancy. Sensitivity, Specificity, positive predictive value, negative predictive value, and accuracy with their cutoff value for malignancy are shown in the full article. Univariate logistic regression analysis showed that both pSR and wSR were significant discriminators for ADC and benign SPL. The overall area under the characteristic curve was 88.6% (81.2%–96.0%), indicating good ability in discriminating between cancers and benign lesions. The major limitation of this study is the low number of benign masses, but these preliminary data showed the feasibility of the SR calculated with the Olympus EU-ME2 echo-processor and the higher SR values in ADC. CONCLUSIONS: EUS-elastography may be helpful in the diagnosis of SPLs, especially in the identification of those suspected for ADC. Further studies are needed to assess its diagnostic accuracy and reproducibility. |
format | Online Article Text |
id | pubmed-5731368 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-57313682017-12-28 Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study Carrara, Silvia Auriemma, Francesco Di Leo, Milena Rahal, Daoud Preatoni, Paoletta Correale, Loredana Anderloni, Andrea Repici, Alessandro Endosc Ultrasound Abstract BACKGROUND AND OBJECTIVES: Endoscopic ultrasound (EUS) elastography is a noninvasive ultrasound technique that measures the stiffness of tissues. Both a qualitative score and a quantitative method (strain ratio [SR]) can be used to study the hardness of solid pancreatic lesions (SPLs). This single-center prospective cohort study aimed to evaluate the efficacy of the combination of EUS elastography and SR for the diagnosis of SPL using the elastography software on the new Olympus echo-processor EU-ME2. METHODS: Two different areas were selected: area A included the tumor; area B was placed in a soft peri-tumoral normal (parenchymal SR [pSR]) and in the gastrointestinal wall (wall SR [wSR]). The quantitative score of elastography was calculated by the SR method (area B/area A). Elasticity measurements were performed 3 times in each procedure. Means of pSR and of wSR were calculated and used as final results for each patient. Final diagnosis was made on the basis of EUS-guided fine needle aspiration, surgical specimens, or follow-up of at least 6 months. RESULTS: Study population included 100 patients and a total of 102 SPLs. Mean lesion (standard deviation) size was 27.1 mm (12.4). The final diagnosis classified SPL into adenocarcinoma (ADC, n = 69) or benign lesions (n = 33). Benign lesion group included 19 neuroendocrine tumors. ROC analysis identified a cutoff of SR of 9.1 as the best value for the detection of malignancy. Sensitivity, Specificity, positive predictive value, negative predictive value, and accuracy with their cutoff value for malignancy are shown in the full article. Univariate logistic regression analysis showed that both pSR and wSR were significant discriminators for ADC and benign SPL. The overall area under the characteristic curve was 88.6% (81.2%–96.0%), indicating good ability in discriminating between cancers and benign lesions. The major limitation of this study is the low number of benign masses, but these preliminary data showed the feasibility of the SR calculated with the Olympus EU-ME2 echo-processor and the higher SR values in ADC. CONCLUSIONS: EUS-elastography may be helpful in the diagnosis of SPLs, especially in the identification of those suspected for ADC. Further studies are needed to assess its diagnostic accuracy and reproducibility. Medknow Publications & Media Pvt Ltd 2017-11 /pmc/articles/PMC5731368/ http://dx.doi.org/10.4103/2303-9027.218430 Text en Copyright: © 2017 Endoscopic Ultrasound http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Abstract Carrara, Silvia Auriemma, Francesco Di Leo, Milena Rahal, Daoud Preatoni, Paoletta Correale, Loredana Anderloni, Andrea Repici, Alessandro Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title | Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title_full | Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title_fullStr | Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title_full_unstemmed | Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title_short | Endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: A prospective cohort study |
title_sort | endoscopic ultrasound-elastography (strain ratio) in the diagnosis of solid pancreatic lesions: a prospective cohort study |
topic | Abstract |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731368/ http://dx.doi.org/10.4103/2303-9027.218430 |
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