Utility of contrast-enhanced harmonic EUS in the diagnosis of malignant gallbladder polyps (with videos).

BACKGROUND

The differential diagnosis between benign and malignant polyps of the gallbladder (GB) is often challenging.

OBJECTIVES

To evaluate whether contrast-enhanced harmonic EUS (CEH-EUS) might be an accurate method for discriminating malignant GB polyps from benign polyps.

DESIGN

Observational study.

SETTING

Tertiary care medical center.

PATIENTS

Ninety-three patients with GB polyps larger than 10 mm in diameter that were detected by conventional EUS underwent CEH-EUS for evaluation of microvasculature.

INTERVENTION

CEH-EUS was performed using a radial echoendoscope and the extended pure harmonic detection mode.

MAIN OUTCOME MEASUREMENTS

The abilities of conventional EUS and CEH-EUS to diagnose malignant polyp were compared. Two blinded reviewers classified the perfusion images into 3 categories: diffuse enhancement, perfusion defect, or nonenhancement. The vessel images were categorized as having a regular spotty vessel, an irregular vessel, or no vessels.

RESULTS

An irregular vessel pattern determined by CEH-EUS aided in the diagnosis of malignant polyps with a sensitivity and specificity of 90.3% and 96.6%, respectively. The presence of perfusion defects, determined by CEH-EUS, was calculated to diagnose malignant polyps with a sensitivity and specificity of 90.3% and 94.9%, respectively. Based on the definitely determined diagnosis, sensitivity and specificity for CEH-EUS were 93.5% and 93.2% versus 90.0% and 91.1% for conventional EUS. In 8 cases, management changed after CEH-EUS.

LIMITATIONS

A tertiary medical center with a limited number of patients.

CONCLUSIONS

The presence of irregular intratumoral vessels or perfusion defects seen on CEH-EUS may be sensitive and accurate predictors of malignant GB polyps. CEH-EUS offers slightly improved diagnostic accuracy compared with EUS.