Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study

Abstract

AIM:To evaluate the ability of endoscopic ultrasound (EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes. METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass (n = 121) or lymph node (n = 101). The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration (EUS-FNA) and/or by surgical pathology. An interobserver study was performed. RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION: EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.

Elastography for the pancreas: Current status and future perspective

“…Cutoff values also quite differ from report to report in strain histogram analysis. The other quantitative diagnostic method is a neural network analysis [57,58] . The neural network analysis is a method developed by Săftoiu et al [58] and is performed by computer which can avoid arbitrary analysis.…”

“…Giovannini et al [57] conducted a multicenter study subjecting 121 patients with pancreatic tumors (92 malignant and 29 benign). In their study, pancreatic tumors were classified according to the following scoring system: Score 1, homogeneous green corresponding to normal tissue; Score 2, heterogeneous soft tissue (green, yellow, and red) corresponding to inflammatory tissue; Score 3, mixed color or honeycombed corresponding to indeterminate; Score 4, small green central area surrounded by mainly blue; Score 5, mainly blue with heterogeneous green and red corresponding advanced malignant lesion [57] . When score 1 and 2 were determined as benign and score 4 and 5 as malignant, sensitivity and specificity were 92.3% and 80%, respectively, and kappa coefficient was shown to be 0.785.…”

The efficacy of endoscopic ultrasonography in local staging of rectal tumors

“…In the study of Giovannini et al (23), sensitivity of US elastography in the detection of malignant lymph nodes was observed as 91.8%. It was also found that lymphovascular invasion was associated closely with advanced primary tumors (T3-T4) and lymph node metastases.…”

The role of endoscopic ultrasonography (EUS) in contemporary diagnosis of gastrointestinal diseases

“…The sensitivity of EUS elastography in differentiating focal lesions is 92% (100% for malignant tumours) and specificity is 80% and 92%, respectively [14].…”