Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis

Abstract

Background and Aim Endoscopic ultrasonography (EUS) findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, may be associated with the severity of chronic pancreatitis (CP). However, the correlation between parenchymal EUS findings and histology remains unclear. We designed a large‐scale retrospective study analyzing over 200 surgical specimens to elucidate the association between parenchymal EUS findings and histological features. Methods Clinical data of 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery between January 2010 and November 2020 were reviewed to investigate the association between parenchymal EUS findings and histological features at the pancreatic body. None of these patients met the definition of CP. Results Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2–7.9] vs 31.3 [9.3–105.6], Ptrend < 0.001; 3.9 [1.9–8.2] vs 21.8 [8.0–59.4], Ptrend < 0.001; and 4.0 [2.0–7.8] vs 22.9 [7.0–74.5], Ptrend < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. Conclusions Endoscopic ultrasonography findings of the pancreatic parenchyma may be associated with the histological conditions in CP, such as pancreatic fibrosis, inflammation, and atrophy. Lobularity reflects more severe histological conditions than does hyperechoic foci/stranding.

Benefits of pancreatic parenchymal endoscopic ultrasonography in predicting microscopic precancerous lesions of pancreatic cancer

“…Abnormal EUS findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, have been identified as representative CP-EUS findings and are included in the diagnostic criteria of early CP in the Rosemont classification 12 and Japanese diagnostic criteria 2019 (DC2019) 13 . Our previous studies and other studies have reported that these EUS findings of pancreatic parenchyma are associated with CP histological conditions, such as fibrosis, inflammation, and atrophy in patients with and without CP 14 – 17 . Given these findings, we hypothesized that the pancreatic parenchymal EUS findings could indirectly predict precancerous pancreatic lesions through the histological changes of the pancreas.…”

“…No patient met the definition of CP as per the DC2019 guidelines 13 . Clinical information included age, sex, body mass index (BMI), DM, alcohol consumption, smoking status, and the type of underlying tumor necessitating pancreatic surgery as in the same method reported previously 17 . The primary outcome of this study was the association between EUS findings and the frequency of microscopic precancerous lesions, including PanINs, ADMs, and PDGs.…”

“…We performed EUS using echo-endoscopes (GF-UCT240, GF-UCT260, or GF-UE260 [Olympus, Tokyo, Japan]) and EUS processors (ProSound α10, Aloka Arietta 850 [HITACHI, Tokyo, Japan] or EU-ME2 Premier Plus [Olympus, Tokyo, Japan]). We assessed the pancreatic parenchymal EUS findings such as hyperechoic foci/stranding and lobularity in the pancreatic body according to DC2019 13 using a method reported previously 17 (Supplementary Fig. S1 a-c).…”

Proposal and Validation of New Diagnostic Criteria for Diagnostic Weights of Endoultrasonographic Findings for Early Chronic Pancreatitis

“…However, if the relation between EUS findings, which constitute one of the criteria for ECP diagnosis, and pathological findings is proven, then the increase in the diagnostic performance of EUS findings, including sensitivity and specificity, will directly engender an increase in the final diagnostic performance of ECP. Recently, it has also been reported that each EUS finding is expected to have its own meaning and reflect pathological findings in CP/ECP [ 23 , 24 ]. Reportedly, atrophy, fibrosis of the pancreatic adenocytes, and inflammatory cell infiltration all lead to lobularity in EUS.…”

Endoscopic Ultrasound in Pancreatology: Focus on Inflammatory Diseases and Interventions

“…According to recent comparison between EUS features and histology on pancreatic specimen, lobularity reflects a more advanced histological stage (i.e., higher degree of inflammation, fibrosis, and atrophy) than the presence of hyperechoic foci and stranding, which can also be found in lower grade inflammation stages [77]. The evaluation of the strain ratio using quantitative EUS elastography allows for the quantification of pancreatic fibrosis and may help diagnose chronic pancreatitis.…”