Abstract
BackgroundThe negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis.AimsTo evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions.MethodsPatients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups.ResultsOperating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%).ConclusionSimultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.
Highlights
The differential diagnosis of solid pancreatic lesions is a common clinical challenge
Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions
Patients with a diagnosis of solid pancreatic lesions based on imaging (CT scan and/or MRI) who underwent Endoscopic ultrasonography (EUS)-fine-needle aspiration (FNA) or contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS)-guided fine needle aspiration (EUS-FNA) from October 2010 to July 2013 were retrospectively identified from a prospectively collected endoscopy database at our center
Summary
The differential diagnosis of solid pancreatic lesions is a common clinical challenge. In this context, the therapeutic decision is mainly based on the ability to establish or exclude malignancy [1]. Endoscopic ultrasonography (EUS) is the most sensitive imaging procedure available for characterizing pancreatic tumors. EUS has a high overall sensitivity, it remains difficult to differentiate pancreatic cancer from other solid lesions on the basis of only endosonographic features [2,9,10,11,12,13,14]. The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis
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