Prospective cohort study comparing transient EUS guided elastography to EUS-FNA for the diagnosis of solid pancreatic mass lesions

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2016-01, Vol.16 (1), p.110-114
• Main Authors: Mayerle, J, Beyer, G, Simon, P, Dickson, E.J, Carter, R.C, Duthie, F, Lerch, M.M, McKay, C.J
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Age; Aged; Aged, 80 and over; Biopsy, Fine-Needle - methods; Cancer; Carcinoma; Chronic pancreatitis; Cohort Studies; Cysts; Cysts - diagnosis; Cysts - pathology; Elasticity Imaging Techniques - methods; Endocrinology & Metabolism; Endosonography; Endosonography - methods; Fine needle aspiration; Gastroenterology and Hepatology; Humans; Metastasis; Middle Aged; Pancreas; Pancreatic mass; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Patients; Sensitivity and Specificity; Strain ratio; Studies; Transient elastography
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2015.10.003

Abstract Background Semiquantitative EUS-elastography has been introduced to distinguish between malignant and benign pancreatic lesions. This study investigated whether semiquantitative EUS-guided transient real time elastography increases the diagnostic accuracy for solid pancreatic lesions compared to EUS-FNA. Patients and methods This single centre prospective cohort study included all patients with solitary pancreatic lesions on EUS during one year. Patients underwent EUS-FNA and semiquantitative EUS-elastography during the same session. EUS and elastography results were compared with final diagnosis which was made on the basis of tissue samples and long-term outcome. Results 91 patients were recruited of which 68 had pancreatic malignancy, 17 showed benign disease and 6 had cystic lesions and were excluded from further analysis. Strain ratios from malignant lesions were significantly higher (24.00; 8.01–43.94 95% CI vs 44.00; 32.42–55.00 95% CI) and ROC analysis indicated optimal cut-off of 24.82 with resulting sensitivity, specificity and accuracy of 77%, 65% and 73% respectively. B-mode EUS and EUS-FNA had an accuracy for the correct diagnosis of malignant lesions of 87% and 85%. When lowering the cut-off strain ratio for elastography to 10 the sensitivity rose to 96% with specificity of 43% and accuracy of 84%, resulting in the least accurate EUS-based method. This was confirmed by pairwise comparison. Conclusion Semiquantitative EUS-elastography does not add substantial value to the EUS-based assessment of solid pancreatic lesions when compared to B-mode imaging.