Qualitative and Quantitative Contrast-enhanced Endoscopic Ultrasound Improves Evaluation of Focal Pancreatic Lesions

Buxbaum, James; Ko, Christopher; Varghese, N. M.; Lee, Alice; Sahakian, Ara; King, Kevin G.; Serna, Jessica; Lee, Helen; Tchelepi, Hisham; Dam, Jacques Van; Duddalwar, Vinay

doi:10.1016/j.cgh.2019.08.054

Cited by 24 publications

(13 citation statements)

References 13 publications

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“…8 In CEH-EUS, values for NEN were high relative peak enhancement (rPE) and normal relative in-slope (rIS); values were low rPE and low rIS for adenocarcinomas. 8 Our case showed a heterogeneous and persistent hyperenhacing contrast pattern, which was compatible with NEN. Elastography of our patient showed a typical heterogeneous stiff pattern which was more compatible with a malignancy.…”

Section: Discussionmentioning

confidence: 97%

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Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone‐producing thymic neuroendocrine neoplasm

Chang

Chen

Cheng

et al. 2020

Digestive Endoscopy

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Adrenocorticotropic hormone (ACTH)‐producing neuroendocrine neoplasm (NEN) of the thymus is rare. Lymph nodes and bones are the most common metastatic sites. Most cases present with florid Cushing's syndrome (CS). Here, we reported a 58‐year‐old woman, who presented with intermittent flush and weight loss. Imaging studies revealed tumors in the mediastinum, pancreas, and bones. Contrast‐enhanced harmonic endoscopic ultrasound (EUS) of the pancreatic tumors showed heterogeneous and hyperenhancing characteristics. EUS elastography revealed a heterogeneous stiff pattern. EUS‐fine needle biopsy to the pancreatic lesion confirmed the NEN nature. Serum ACTH and cortisol levels were abnormally high. Immunohistochemical staining of the thymic and pancreatic specimens was positive for ACTH. However, the patient did not have obvious CS appearance. The patient underwent surgery, radiation, EUS‐guided ethanol injection, and anti‐cancer medications, but the disease still progressed. The patient died from infection 16 months after NEN was diagnosed. In conclusion, the pancreas can be a metastatic site for ACTH‐producing thymic NEN. EUS‐associated procedures can help in the diagnosis and treatment of pancreatic metastatic NEN.

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Section: Discussionmentioning

confidence: 97%

“…Contrast‐enhanced harmonic‐EUS and elastography have been shown to improve evaluation of pancreatic lesions 8 . In CEH‐EUS, values for NEN were high relative peak enhancement (rPE) and normal relative in‐slope (rIS); values were low rPE and low rIS for adenocarcinomas 8 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone‐producing thymic neuroendocrine neoplasm

Chang

Chen

Cheng

et al. 2020

Digestive Endoscopy

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“…Analysis software has been developed in an attempt to provide some degree of quantitative assessment for CH-EUS (Seicean et al 2010;Imazu et al 2012;S aftoiu et al 2015;Omoto et al 2017;Takada et al 2019;Buxbaum et al 2020). Although limitations remain in quantitative analysis because of the subjectivity involved in determining a region of interest, combination of qualitative and quantitative analyses may improve the diagnostic ability of CH-EUS.…”

Section: Discussionmentioning

confidence: 99%

The Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) Guidelines for Contrast-Enhanced Endoscopic Ultrasound

Kitano

Yamashita

Kamata

et al. 2021

Ultrasound in Medicine & Biology

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The Asian Federation of Societies for Ultrasound in Medicine and Biology aimed to provide information on techniques and indications for contrast-enhanced harmonic endoscopic ultrasound (CH-EUS), and to create statements including the level of recommendation. These statements are based on current scientific evidence reviewed by a Consensus Panel of 15 internationally renowned experts. The reliability of clinical questions was measured by agreement rates after voting. Six statements were made on techniques, including suitable contrast agents for CH-EUS, differences between contrast agents, setting of mechanical index, dual imaging and duration and phases for observation. Thirteen statements were made on indications, including pancreatic solid masses, pancreatic cancer staging, pancreatic cystic lesions and mural nodules, detection of subtle pancreatic lesions, gallbladder sludge and polyps, hepatic lesions, lymph nodes, subepithelial lesions, visceral vascular diseases, guidance of fine needle aspiration and evaluation for local therapy. These international expert consensus guidelines will assist endosonographers in conducting CH-EUS according to evidence-based information.

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“…In addition, technologic advances in EUS such as contrast-enhanced harmonics and elastography offer improved diagnostic accuracy in patients with chronic pancreatitis. 17,18 As a result, EUS is being increasingly used as a frontline test for this indication.…”

Section: Pancreatic Fl Uid Collectionsmentioning

confidence: 99%

Endoscopic ultrasonography: An inside view

Simons-Linares

Wander

Vargo

et al. 2020

CCJM

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Endoscopic ultrasonography (EUS) has been used since the mid-1980s. Initially a diagnostic tool, it has since evolved into a therapeutic, minimally invasive surgical tool with signifi cant impact on the diagnosis and management of a range of benign and malignant conditions. The authors review current indications, safety, and effi cacy of EUS for diseases of the upper and lower gastrointestinal tract, posterior mediastinum, pancreas, bile duct, gallbladder, retroperitoneum, liver, adrenal glands, and kidneys. KEY POINTSEUS is commonly used in the diagnosis and management of biliary and pancreatic diseases, including guidance of biliary drainage in bile duct or pancreatic duct obstruction.EUS-guided fi ne-needle aspiration aids staging of malignancies of the upper and lower digestive tract.EUS is now increasingly used to drain abdominal fl uid collections of nonpancreatic etiology.

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Qualitative and Quantitative Contrast-enhanced Endoscopic Ultrasound Improves Evaluation of Focal Pancreatic Lesions

Cited by 24 publications

References 13 publications

Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone‐producing thymic neuroendocrine neoplasm

Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone‐producing thymic neuroendocrine neoplasm

The Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) Guidelines for Contrast-Enhanced Endoscopic Ultrasound

Endoscopic ultrasonography: An inside view

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