Bajaj Kiran, Yaseen Taha, Tasneem Abbas Ali, Laeeq Syed Mudassir, Khalid Ali, Luck Nasir Hasan, Mehmood Nasir, Kumar Sandeep, Panezai Muhammad Qaiser, Kumar Danish, Sattar Nadir, Rasool Nida, Kumari Reeaa
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan.
Euroasian J Hepatogastroenterol. 2023 Jan-Jun;13(1):1-4. doi: 10.5005/jp-journals-10018-1386.
Despite advancement in imaging techniques, the diagnosis of solid pancreatic lesions (SPLs) remains challenging. The latest advancement in elastography permits the quantitative measurements of the average elasticity of a lesion. Therefore, our main aim of this study was to determine the utility of endoscopic ultrasound-guided elastography (EUS-EG) and strain ratio (EUS-SR) in predicting SPLs.
This cross-sectional study was performed at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. All patients with radiological diagnosis of SPLs underwent EUS-EG, followed by strain ratio (SR) measurement and targeted pancreatic fine needle lesion biopsy (FNB). Area under the receiver operating curve (AUROC) was obtained for SR and combined elastography and SR and at an optimal cutoff, diagnostic accuracy was obtained in predicting the nature of SPLs.
A total of 52 patients were included in this study. Out of them, 32 (61.5%) patients were males while 20 (38.5%) were females. The mean age was 50.8 ± 12.5 years. Twenty-four (46.2%) patients had malignant pancreatic lesions. Among malignant lesions, the most common etiology was pancreatic adenocarcinoma seen in 18 (34.6%) patients. Out of 28 (53.8%) patients with benign lesions, 14 (26.9%) patients had inflammatory disease. Area under the receiver operating curve was obtained for both SR alone and SR combined with elastography score in differentiating benign from malignant SPLs which was 0.832 (-value < 0.001) for SR alone and a slightly higher for combined SR with elastography (AUROC-0.839)(-value < 0.001). At an optimal cutoff of SR of >17, the sensitivity was 94.8% and the diagnostic accuracy was 74% in predicting SPLs. While, when SR and elastography were combined together, the sensitivity increased to 96% with a diagnostic accuracy of 75%.
Combined EUS-EG and SR were accurate in diagnosing malignant pancreatic lesions with a diagnostic accuracy of 75% providing additional diagnostics information before biopsy. However, multicentric studies with larger sample sizes are required for the validation of our results to determine the utility and diagnostic accuracy of EUS-SR in defining the characteristic of pancreatic lesions.
Bajaj K, Yaseen T, Tasneem AA, . Role of Endoscopic Ultrasound in Predicting Solid Pancreatic Lesions Using Strain Ratio and Elastography. Euroasian J Hepato-Gastroenterol 2023;13(1):1-4.
尽管成像技术不断进步，但实性胰腺病变（SPLs）的诊断仍具有挑战性。弹性成像的最新进展允许对病变的平均弹性进行定量测量。因此，本研究的主要目的是确定内镜超声引导弹性成像（EUS-EG）和应变率（EUS-SR）在预测SPLs中的效用。
本横断面研究在信德泌尿与移植研究所肝病胃肠病科进行。所有经放射学诊断为SPLs的患者均接受EUS-EG检查，随后进行应变率（SR）测量和靶向胰腺细针病变活检（FNB）。获得SR以及联合弹性成像和SR的受试者操作曲线下面积（AUROC），并在最佳截断值下，获得预测SPLs性质的诊断准确性。
本研究共纳入52例患者。其中，32例（61.5%）为男性，20例（38.5%）为女性。平均年龄为50.8±12.5岁。24例（46.2%）患者患有恶性胰腺病变。在恶性病变中，最常见的病因是胰腺腺癌，见于18例（34.6%）患者。在28例（53.8%）良性病变患者中，14例（26.9%）患有炎症性疾病。单独使用SR以及SR与弹性成像评分联合用于区分良性和恶性SPLs的受试者操作曲线下面积分别为0.832（P值<0.001）和稍高的SR与弹性成像联合（AUROC-0.839）（P值<0.001）。在SR的最佳截断值>17时，预测SPLs的敏感性为94.8%，诊断准确性为74%。而当SR和弹性成像联合使用时，敏感性提高到96%，诊断准确性为75%。
EUS-EG和SR联合在诊断恶性胰腺病变方面具有准确性，诊断准确性为75%，在活检前提供了额外的诊断信息。然而，需要进行更大样本量的多中心研究来验证我们的结果，以确定EUS-SR在定义胰腺病变特征方面的效用和诊断准确性。
Bajaj K, Yaseen T, Tasneem AA, 等。内镜超声在使用应变率和弹性成像预测实性胰腺病变中的作用。欧亚肝脏胃肠病学杂志2023；13(1):1-4。
