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

Abstract

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.

Value of artificial intelligence with novel tumor tracking technology in the diagnosis of gastric submucosal tumors by contrast‐enhanced harmonic endoscopic ultrasonography

“…A meta-analysis found that the pooled sensitivity, specificity, and accuracy of CH-EUS for discriminating between GIST and benign SMT were 89%, 82%, and 89%, respectively. 29 Few studies, however, have evaluated the ability of CH-EUS to diagnose g-SMTs, 29,30 and its diagnostic performance has been found to vary. 30 In the present study, evaluation of CH-EUS findings by blinded readers had a sensitivity, specificity, and accuracy of 90.5%, 81.8%, and 88.7%, respectively.…”

Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence

“…In collaboration with European experts in a recently issued guideline, the Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) concluded that the MI should be between 0.2 and 0.4. They added that the 0.1 to 0.4 range used in published reports was influenced by several factors, including EUS probe type (radial or linear), image processing hardware, and software, phase-inversion harmonics, amplitude modulations, and focal points[ 27 ].…”

“…AFSUMB, in their summary recommendations, alluded to the benefit of contrast-enhanced harmonic EUS (CH-EUS) for characterization of solid pancreatic masses, pancreatic cancer staging in patients with suspected major vessel involvement, identification of mural nodules in cystic pancreatic lesions, and detection of subtle pancreatic lesions[ 27 ].…”

“…The AFSUMB working group strongly recommends the following for use as UCAs: SonoVue (Lumason, sulfur hexafluoride micro-bubbles; Bracco, Milan, Italy; available in Europe, China, India, Korea, Hong Kong, New Zealand, Singapore, and Brazil); Definity (octafluoropropane microbubbles; Bristol- Myers Squibb Medical Imaging, New York, NY, United States; available in the United States, Canada, and Australia), and Sonazoid (perfluorobutane microbubbles; GE Healthcare, Chicago, IL, United States; Daiichi Sankyo, Tokyo, Japan; available in Japan, South Korea, Taiwan and Norway). They further stated that neither of the agents had a superior diagnostic ability over the other[ 27 ].…”

The Role of Contrast-Enhanced Harmonic Endoscopic Ultrasound in Interventional Endoscopic Ultrasound

“…Several studies have explored its potential benefit in EUS-guided tissue acquisition, in the management of pancreatic fluid collection (PFC), biliary and pancreatic duct drainage, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections, and in targeted cancer chemotherapy and radiotherapy. Moreover, guidelines on CH-EUS have been recently published from the Asian Federation of Societies for Ultrasound in Medicine and Biology [ 7 ], providing evidence-based information on technical aspects and indications. In parallel to the widespread of interventional EUS-guided procedures, indeed, CH-EUS could represent an important tool to delineate real-time vascular perfusion and to enhance imaging, in order to have a proper guidance and reduce potential complications.…”