Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Early Diagnosis of Small Pancreatic Cancer

Abstract

This study aimed to assess whether contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), compared to multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), is useful for early diagnosis of small pancreatic cancer (PC). Between March 2010 and June 2018, all three imaging modalities and surgery were performed for patients with a pancreatic solid lesion measuring ≤20 mm; diagnostic ability was compared among modalities. Fifty-one of 60 patients were diagnosed with PC (PC size in 41 patients: 11–20 mm; 10 patients: ≤10 mm). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (11–20 mm) detection were 95%/83%/94%, 78%/83%/79%, and 73%/33%/68%, respectively. The diagnostic ability of CH-EUS was significantly superior compared with MDCT and MRI (p = 0.002 and p = 0.007, respectively). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (≤10 mm) detection were 70%/100%/77%, 20%/100%/38%, and 50%/100%/62%, respectively. The diagnostic ability of CH-EUS tended to be superior to that of MDCT (p = 0.025). The sensitivity of MDCT for PC (≤10 mm) detection was significantly lower than that for PC (11–20 mm) detection (20% vs. 78%; p = 0.001). CH-EUS, compared to MDCT and MRI, is useful for diagnosing small PCs.

A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study

“…Contrast-enhanced EUS (CE-EUS) increases the detectability of vessels and can overcome some of these limitations. Indeed, many studies demonstrate the utility of CE-EUS for diagnosis of pancreatobiliary lesions [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]; thus, the technique is used widely in the clinic. However, there are some problems.…”

Do we need contrast agents for EUS?

“…[ 21 22 ] Another Japanese study confirmed these data and showed superiority of CE-EUS in diagnosing early pancreatic cancer (≤20 mm) compared to MDCT and magnetic resonance imaging (MRI). [ 22 ] The clinical accuracy of CE-EUS for the diagnosis of PDAC versus non-PDAC lesions in pancreatic solid lesions <15 mm has been confirmed in a recent multicenter trial including 219 patients, indicating an overall 89% accuracy of CE-EUS. [ 20 ] Recently, time–intensity curve analysis has also been used with a high diagnostic accuracy of 91% to characterize focal pancreatic lesions.…”

“…[ 20 ] In a Japanese study, the sensitivity of CE-EUS was 91.2%, while the corresponding sensitivity of contrast-enhanced MDCT imaging was only 70.6%. [ 21 22 ] Another Japanese study confirmed these data and showed superiority of CE-EUS in diagnosing early pancreatic cancer (≤20 mm) compared to MDCT and magnetic resonance imaging (MRI). [ 22 ] The clinical accuracy of CE-EUS for the diagnosis of PDAC versus non-PDAC lesions in pancreatic solid lesions <15 mm has been confirmed in a recent multicenter trial including 219 patients, indicating an overall 89% accuracy of CE-EUS.…”

Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

“…In four meta-analyses, the pooled sensitivity and specificity of CE-EUS in the diagnosis of pancreatic cancer were 91–93% and 80–88%, respectively [ 30 , 31 , 32 , 33 ]. In addition, Yamashita et al [ 34 ] reported that the sensitivity of CE-EUS for the detection of pancreatic cancer in small pancreatic masses of 11–20 mm was significantly better than that of MDCT and MRI (95% compared to 78%, and 73%, respectively), and that the sensitivity of CE-EUS in pancreatic masses of 10 mm or less was also significantly better than that of MDCT (70% and 20%, respectively).…”