Diagnostic Efficacy of Endoscopic Ultrasound Elastography in Differentiating Solid Pancreatic Lesions: A Single-Center Experience

Abstract

Background/Aims Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions. Methods The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed. Results In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%. Conclusions The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.

Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

“…Pixel values within the region of interest were converted to color images within the range of 0 (red) for minimum hardness to 255 (blue) for maximum hardness, which created a distribution histogram. Reported evaluation methods by strain elastography include a qualitative evaluation method using color pattern [ 35 , 36 , 37 , 38 , 39 ] and a quantitative evaluation method measuring strain ratio, strain histogram, and neural network [ 22 , 25 , 40 , 41 , 42 , 43 , 44 , 45 ]. On the other hand, shear wave elastography can measure the absolute value of tissue hardness by calculating the propagation velocity of shear waves and Young’s modulus.…”

Utilidad de la elastografía cuantitativa por ultrasonografía endoscópica (USE), para el diagnóstico de las lesiones sólidas del páncreas (LSP).

“…ej., visualización del gráfico de deformación) (70,(79)(80)(81) . Por su parte, el VPP de 89,8 % (IC 95 %: 79,5 %-95,3 %), VPN de 94,3 % (IC 95 %: 84,6 %-98,1 %) y exactitud del 92,0 % (IC 95 %: 85,4 %-95,7 %) son resultados congruentes con los encontrados en un estudio recientemente publicado retrospectivo de 116 pacientes (97 con lesiones malignas y 19 con lesiones benignas), con una mediana de edad de 55,9 años; se usó un punto de corte de SR de 7,75 con una especificidad del 99,9 %, sensibilidad del 90,7 %, VPP del 99,9 %, VPN del 67,9 % y precisión del 92,2 % (82) .…”

Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value

“…Malignant tissue is often more rigid than the normal surrounding tissue; thus, EUS elastography can differentiate between malignant and nonmalignant lesions. As a result, this technique has been applied in the diagnostic workup of PMs and their associated LNs[ 2 - 4 ]. EUS elastography is considered an accurate imaging technique for characterizing and detecting pancreatic lesions[ 2 ].…”

“…EUS elastography can be used to evaluate PMs and their associated LNs through qualitative and quantitative analyses; the former involves the analysis of color maps, while the latter is achieved by assessing the strain ratio (SR). However, previous studies, such as the one published by Altonbary et al [ 4 ], have reported differences in the SR cutoff value and the optimal internal sensitivity and specificity, suggesting a potential limitation of this technique[ 3 , 4 ]. The accuracy of this technique in differentiating malignant from nonmalignant lesions has only been assessed for masses consisting of solid tissue.…”