Abstract
Elastography endoscopic ultrasound (E-EUS) has been proved to be a valuable supplement to endoscopic ultrasound fine-needle aspiration (EUS-FNA) in differentiating solid pancreatic lesions, but the improvement of EUS-FNA guided during E-EUS has not been proven. Our study aimed to evaluate whether E-EUS fine-needle aspiration (E-EUS-FNA) was superior to B-mode EUS-FNA for the diagnosis of solid pancreatic masses and whether the diagnostic rate was affected by specific factors. Our prospective study was conducted between 2019–2020 by recruiting patients with solid pancreatic masses. E-EUS examination was followed by one pass of E-EUS-FNA towards the blue part of the lesion and a second pass of EUS-FNA. The final diagnosis was based on surgery, E-EUS-FNA or EUS-FNA results, or a 12-month follow-up. Sixty patients with solid pancreatic lesions were evaluated. The sensitivity, specificity, and accuracy for diagnosing malignancy using E-EUS-FNA and EUS-FNA were 89.5%, 100%, 90%, 93%, 100%, and 93.3%, respectively, but the differences were not significant. Neither mass location nor the lesion size influenced the results. The lengths of the core obtained during E-EUS-FNA and EUS-FNA were similar. E-EUS-FNA in solid pancreatic lesions was not superior to B-mode EUS-FNA.
Highlights
Introduction iationsThe endoscopic ultrasound (EUS) tools for assessing solid pancreatic lesions include strain elastography, which evaluates the stiffness of the tissue based on elastic pattern, strain ratio, or strain histogram
Our study aimed to evaluate if Elastography endoscopic ultrasound (E-EUS)-FNA is superior to standard endoscopic ultrasound fine-needle aspiration (EUS-FNA) in solid pancreatic masses diagnosis and identify the factors affecting the diagnostic rate
The semi-quantitative analysis of elastography images using the strain response or hue histogram [9,10,11] did not obtain a better diagnostic rate, concluding that tissue acquisition cannot be replaced by elastography
Summary
The endoscopic ultrasound (EUS) tools for assessing solid pancreatic lesions include strain elastography, which evaluates the stiffness of the tissue based on elastic pattern, strain ratio, or strain histogram. Elastography EUS (E-EUS) assessment proved useful in discriminating solid pancreatic tumors smaller than 30 mm, as showed by a meta-analysis, with a sensitivity of 98% (95% CI: 0.96–0.99, CI = confidence interval), and a specificity of 63% (95% CI: 0.58–0.69), but without the possibility to obtain the tissue acquisition such as EUS fine-needle aspiration (EUS-FNA) or EUS fine needle biopsy (FNB) [2]. Even in the case of lesions smaller than 15 mm, E-EUS sensitivity for malignancy was 84%, with 67% specificity, but with a negative predictive value of 98%, sustaining that a small soft lesion rules out the diagnosis of malignancy [3].
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