Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

Abstract

The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses. In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months' follow-up. The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods' results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy. CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.

Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

“…Although this does not obviate the need for EUS-FNA it might certainly better select the patients and bring significant improvements in the methodology of EUS-FNA concerning the types of needle used, number of passes, cytology versus microhistology (core) biopsy, dedicated passes for ancillary studies, etc [24]. A recent published study revealed that CEH-EUS guided FNA has a better accuracy [25]. Moreover, fewer needle passes are required to obtain samples [26].…”

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

“…Pancreatic neuroendocrine tumors typically show hyperenhancement followed by "wash-out", filling defects being predictive of malignancy [170]. CHI-EUS can be used complementary to EUS-FNA in order to increase the diagnostic yield and accuracy through the guidance of the needle during real-time CEUS [171].…”

Contrast‐Enhanced Ultrasound for the Assessment of Pancreatic Lesions

“…CE-EUS with low mechanical index has been used similarly to transabdominal CEUS to differentiate between pseudotumoral CP and ductal adenocarcinoma, but also to guide FNA in order to avoid avascular areas, improving the diagnostic accuracy of FNA [54]. Quantitative postprocedural assessment of uptake of the contrast agent has been proven useful to improve the accuracy of CE-EUS with low mechanical index for differentiating between the two entities [55,56].…”