Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors

• Published in: BioMed research international 2015-01, Vol.2015 (2015), p.1-8
• Main Authors: Itonaga, Masahiro, Maeda, Hiroki, Maekita, Takao, Iguchi, Mikitaka, Tamai, Hideyuki, Ichinose, Masao, Tamura, Takashi, Nuta, Junya, Abe, Hiroko, Kawaji, Yuki, Nakamura, Yasushi, Ueda, Kazuki, Kato, Jun, Yamashita, Yasunobu, Yoshida, Takeichi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - physiopathology; Clinical Study; Contrast media; Contrast Media - administration & dosage; Diagnosis; Diagnosis, Differential; Endoscopic ultrasonography; Endoscopy; Endosonography; Female; Histology; Humans; Image Enhancement; Male; Medical imaging; Medical prognosis; Methods; Middle Aged; Mortality; Pancreas; Pancreas - diagnostic imaging; Pancreas - physiopathology; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - physiopathology; Tumors
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2015/491782

Objectives. To investigate the usefulness of contrast-enhanced endoscopic ultrasonography (CE-EUS) for histological differentiation of pancreatic tumors. Methods. CE-EUS was performed for consecutive patients having a pancreatic solid lesion, and tumors were classified into three vascular patterns (hypervascular, isovascular, and hypovascular) at two time phases (early-phase and late-phase). Correlation between vascular patterns and histopathology of resected pancreatic cancer (PC) tissues was ascertained. Results. The final diagnoses of 147 examined tumors were PC ( n = 109 ) , inflammatory mass ( n = 11 ) , autoimmune pancreatitis ( n = 9 ) , neuroendocrine tumor ( n = 8 ) , and others ( n = 10 ) . In late-phase images, 104 of 109 PCs had the hypovascular pattern, for a diagnostic sensitivity and specificity of 94% and 71%, respectively. Of 28 resected PCs, 10 had isovascular, and 18 hypovascular, patterns on the early-phase image. Early-phase isovascular PCs were more likely to be differentiated than were early-phase hypovascular PCs (6 well and 4 moderately differentiated versus 3 well, 14 moderately, and 1 poorly differentiated, P = 0.028 ) . Immunostaining revealed that hypovascular areas of early-phase images reflected heterogeneous tumor cells with fibrous tissue, necrosis, and few vessels. Conclusion. CE-EUS could be useful for distinguishing PC from other solid pancreatic lesions and for histological differentiation of PCs.