Unité d'Exploration Médico-Chirurgicale Oncologique, Institut Paoli-Calmettes, France ; Gastroenterology Department, University of the State of Rio de Janeiro and Federal University of Rio de Janeiro, Brazil.
Biopathology Unit, Institut Paoli-Calmettes, France.
Endosc Ultrasound. 2012 Oct;1(3):143-9. doi: 10.7178/eus.03.005.
Although endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the gold standard for diagnosing pancreatic lesions, its negative predictive value is suboptimal. Our aim was to evaluate the yield of contrast-enhanced EUS (CED-EUS) and of strain ratio EUS-elastography (SR-E-EUS) for differentiating pancreatic solid lesions.
Forty-seven patients (27 men, 20 women, 70 ± 11 years) were consecutively involved in this single-center, prospective study. They were submitted to EUS, SR-E-EUS, CED-EUS with Sonovue(®), and EUS-FNA. The final diagnosis was based on the histological assessment of EUS-FNA and/or surgical specimens when available, and on follow-up of at least 6 months.
From the 47 focal pancreatic lesions included, 13 (28%) were benign and 34 (72%) malignant. Patients with malignancy were older (70 ± 11 vs. 61 ± 8, P = 0.003), and had larger lesions (34 ± 12 mm vs. 22 ± 11 mm, P = 0.03). Malignant lesions had higher SR-E-EUS (31 ± 32 vs. 8 ± 9, P = 0.001) and more hypovascular pattern (93% vs. 33%, P < 0.001). Logistic regression determined that only hypovascularity (OR = 2.6, 95%CI: 1.5-130, P = 0.02) was independently predictive of malignancy. ROC analysis for SR-E-EUS yielded an optimal cutoff of 8 (AUC 0.91, 95%CI: 0.74-0.98) for the best power distinction for malignancy. There was no significant difference concerning sensitivity (79%, 90%, 93%) and specificity rates (85%, 75%, 67%) of EUS-FNA, SR-E-EUS, and CED-EUS, respectively. By analysis of the inconclusive EUS-FNA subset (9 patients, 19%), SR-E-EUS > 8 and hypovascularity showed sensitivity of 80% and 100%, and specificity of 67% and 67%, respectively.
The clinical utility of CED-EUS and SR-E-EUS remains questionable. The accuracies of CED-EUS and SR-E-EUS are similar to EUS-FNA. Hypovascularity was independently predictive of malignancy. Patients with inconclusive EUS-FNA could benefit from CED-EUS due to the high sensitivity of hypovascularity for diagnosing malignancy.
尽管内镜超声引导下细针抽吸术（EUS-FNA）是诊断胰腺病变的金标准，但它的阴性预测值并不理想。我们的目的是评估对比增强超声（CED-EUS）和应变比超声弹性成像（SR-E-EUS）在鉴别胰腺实性病变方面的应用价值。
47 例患者（男 27 例，女 20 例，70±11 岁）连续参与了这项单中心前瞻性研究。他们接受了 EUS、SR-E-EUS、CEDEUS 联合 SonoVue（®）和 EUS-FNA。最终诊断基于 EUS-FNA 的组织学评估和/或手术标本，如有，并进行至少 6 个月的随访。
47 个局灶性胰腺病变中，13 个（28%）为良性，34 个（72%）为恶性。恶性肿瘤患者年龄更大（70±11 岁 vs. 61±8 岁，P=0.003），病变更大（34±12 毫米 vs. 22±11 毫米，P=0.03）。恶性病变的 SR-E-EUS 值更高（31±32 与 8±9，P=0.001），且更倾向于低血流灌注模式（93%与 33%，P<0.001）。Logistic 回归分析确定，只有低血流灌注（OR=2.6，95%CI：1.5-130，P=0.02）是恶性肿瘤的独立预测因素。SR-E-EUS 的 ROC 分析得到了一个最佳的截断值为 8（AUC 0.91，95%CI：0.74-0.98），以区分良恶性病变。EUS-FNA、SR-E-EUS 和 CED-EUS 的诊断恶性肿瘤的敏感性（分别为 79%、90%和 93%）和特异性（分别为 85%、75%和 67%）差异无统计学意义。通过对 EUS-FNA 不确定的亚组（9 例，19%）进行分析，SR-E-EUS>8 和低血流灌注的敏感性分别为 80%和 100%，特异性分别为 67%和 67%。
CED-EUS 和 SR-E-EUS 的临床应用价值仍存在疑问。CED-EUS 和 SR-E-EUS 的准确性与 EUS-FNA 相似。低血流灌注是恶性肿瘤的独立预测因素。EUS-FNA 不确定的患者可以从 CED-EUS 中受益，因为低血流灌注对诊断恶性肿瘤的敏感性很高。
