Diagnostic Value Of Endoscopic Ultrasonography Research Articles

Diagnostic Value of Endoscopic Ultrasonography (EUS) in Unexplained Common Bile Duct Dilatation

Diagnostic Value of Endoscopic Ultrasonography (EUS) in Unexplained Common Bile Duct Dilatation

Diagnostic value of endoscopic ultrasonography in pelvic masses with bowel involvement.

Benign and malignant pelvic masses with or without intestinal invasion are common in women of childbearing age. Patients may have nonspecific symptoms and signs or experience no symptoms. Laparoscopic resection of pelvic masses is currently the mainstream treatment; therefore, accurate preoperative evaluation is not only essential for patients suspected of having intestinal invasion, but also extremely important for the selection of follow-up treatment. Procedures, including endoscopic ultrasonography (EUS), pelvic magnetic resonance imaging, abdominal computed tomography, vaginal ultrasonography, barium enema, and colonoscopy, aid in determining the presence, depth, and histology of the disease. In particular, the wide application and continuous developments in EUS techniques have improved the diagnostic accuracy for intestinal subepithelial and peripheral organ lesions. This article reviewed the clinical value of EUS in the diagnosis of benign and malignant pelvic masses with bowel involvement.

Diagnostic value of endoscopic ultrasonography in periampullary duodenal tumours.

The objective of this study was to investigate the diagnostic value of endoscopic ultrasonography (EUS) for tumours around the duodenal ampullary. A retrospective analysis was performed on cases diagnosed and treated in our hospital from October 2016 to August 2021 due to the lesions around the duodenal ampulla. All patients received EUS, abdominal enhanced computed tomography (CT) and magnetic resonance imaging combined with magnetic resonance cholangiopancreatography (MRI-MRCP). Pathological diagnosis was used to verify the accuracy of the imaging findings. The detection rates of periampullary tumours by EUS, abdominal enhanced CT and MRI-MRCP were determined and compared. A total of 86 patients were included in this study. According to the pathological diagnosis, the detection rate of EUS was 87% (36/41) for periampullary tumour lesions with a tumour diameter <1 cm, which was significantly higher than that of MRI-MRCP (59%, 24/41) (P = 0.003) and CT (44%, 18/41) (P < 0.001). For periampullary tumour lesions with a tumour diameter ≥1 cm, the detection rate of MRI-MRCP was 93% (42/45), which was significantly higher than that of EUS (78%, 35/45) (P = 0.036) and CT (76%, 34/45) (P = 0.02). EUS can accurately detect tumour lesions around the ampullary part of the duodenum with minimal gas interference. For periampullary tumour lesions <1 cm, EUS has better diagnostic accuracy than abdominal-enhanced CT and MRI-MRCP. In addition, a biopsy of the lesion can be performed at the same time during the EUS examination. Therefore, EUS has an important clinical significance and value in the diagnosis of duodenal periampullary tumours.

Diagnostic Value of Endoscopic Ultrasonography for Common Bile Duct Dilatation without Identifiable Etiology Detected from Cross-Sectional Imaging.

Background/AimsEndoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology. MethodsRetrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017. ResultsA total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98 (95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91 (95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× the upper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathological obstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively. ConclusionsEUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectional imaging.

Diagnostic value of endoscopic ultrasonography in patients with biliary-pancreatic duct dilatation

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD). Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional ultrasonography (US) were re-examined by EUS, CT and MRI. The diagnostic rates of EUS and the other imaging technologies were compared. Results All the 45 patients underwent successful EUS examination. Among them, there were 18 patients with periampullary tumor, 10 patients with lower common bile duct stones, 1 patient with pancreatic duct stones, 3 patients with chronic pancreatitis, 1 patient with an intrapancreatic choledochal cyst, 4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis. However, 1 patient with a lower common bile duct tumor, 1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed. The diagnostic rates of obstructive lesions by US, EUS, CT and MRI were 7.1%, 92.9%, 33.3%, 31.0%, respectively. The diagnostic rates of tumor were 10.0%, 90.0%, 35.0%, 25.0%, respectively. As compared with the other examination methods, EUS was best in detecting small carcinoma. Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation. Key words: Ultrasonography; Bile duct diseases; Pancreatic ducts; Endoscopic ultrasonography; Diagnosis

Diagnostic value of endoscopic ultrasonography, fibroscan, acoustic radiation pulse imaging, serological index, and their combination for early stage liver cirrhosis

Objective: To investigate the diagnostic value of endoscopic ultrasonography (EUS), Fibroscan, acoustic radiation force impulse (ARFI), and aspartate aminotransferase-to-platelet ratio (APRI) and their combination for early stage liver cirrhosis. Methods: Three hundred and twenty-two hospitalized patients who had been diagnosed with chronic viral liver disease from March 2016 to April 2018 were included. According to the clinical diagnosis, patients were divided into chronic hepatitis and the early stage liver cirrhosis group (Child-Pugh A grade). All patients were examined by Fibroscan to detect liver stiffness measurement (LSM), ARFI to detect liver virtual touch tissue quantification (VTQ) value, esophagogastroduodenoscopy and EUS to detect esophagogastric varices, laboratory and imaging examination. The index of EUS, Fibroscan, ARFI, and APRI was analyzed and the regression model was established by binary logistic regression, and the diagnostic efficacy of the above index and regression model for early stage of cirrhosis was evaluated by the area under a receiver operating characteristic curve (AUROCs). Results: An early stage cirrhosis group had significantly higher detection rate with EUS (esophagogastric varices), Fibroscan (LSM), ARFI (VTQ) and APRI than chronic hepatitis group [76.7% vs. 10.7%, 10.4 (7.8, 17.3) vs. 6.1 (5.2, 8.4) kPa, 1.71(1.48, 2.07) m/s vs. 1.25(1.14, 1.43) m/s and 0.65 (0.38, 1.15) vs. 0.38(0.26, 0.62), respectively]. The corresponding chi-square test were 140.86, Z = -9.069, Z = -9.948 and Z = -5.764, respectively and the differences were statistically significant (P < 0.01). The areas under the receiver operating characteristic curve and regression model were 0.830 (0.783 ~ 0.877), 0.793 (0.744 ~ 0.841), 0.821 (0.775 ~ 0.868), 0.686 (0.628 ~ 0.744) and 0.947 (0.925 ~ 0.969) for the diagnosis of early stage cirrhosis, respectively. Among them, the regression model of three indices (EUS, LSM and VTQ) had the largest AUROCs (0.947) and the corresponding sensitivity and specificity were 0.878 and 0.867, respectively. Conclusion: The combination of EUS, LSM and ARFI had a superior diagnostic value for early stage liver cirrhosis, and may improve the diagnosis rate and reduce the misdiagnosis rate.

Diagnostic value of endoscopic ultrasonography combined with liver stiffness measurement and liver histopathology for early liver cirrhosis

Objective To evaluate the value of endoscopic ultrasonography(EUS) alone for early liver cirrhosis and the diagnostic efficacy of EUS combined with liver histopathology (LH) and liver stiffness measurement (LSM) for early liver cirrhosis. Methods Data of 226 patients with chronic liver lesions who underwent endoscopy and EUS at Tianjin Second People's Hospital were collected to assess esophageal and gastric varices. Liver fibrosis was assessed by LH and LSM was determined by Fibroscan. Models of EUS-LSM, EUS-LH, LSM-LH, ELL (EUS, LSM and LH) were constructed to predict early liver cirrhosis. The ROC curve and AUROC were used to evaluate the efficacy of different models in the diagnosis of early liver cirrhosis. Results A total of 149 patients were diagnosed as chronic liver disease and 77 patients were diagnosed as early liver cirrhosis (Child-Pugh A grade) by clinical evaluation. Ratio of varices found by EUS was significantly higher than that by endoscopy [68.8% (53/77) VS 32.5% (25/77), P<0.05]. The cut-off value was 8.65 kPa by LSM to predict early liver cirrhosis. Pseudolobules were confirmed by LH in 42(54.5%) patients in the early liver cirrhosis group. The AUROC of ELL was 0.919 (95%CI: 0.875-0.951), sensitivity=0.792, specificity=0.913, PPV=0.824, NPV=0.895, + LR=9.08, -LR=0.23, accuracy=0.872, and ELL was superior to EUS (P<0.000 1), LSM (P<0.000 1), LH (P<0.000 1), EUS-LSM (P<0.000 1), EUS-LH (P=0.013 4) and LSM-LH (P=0.002 2) in the diagnosis of early liver cirrhosis. Conclusion EUS is superior to endoscopy in detecting the varices for early liver cirrhosis. Combination of EUS with LSM and LH can improve diagnostic efficacy for early liver cirrhosis. Key words: Ultrasonography; Pathology; Liver cirrhosis; Liver stiffness measurement

Diagnostic Value of Endoscopic Ultrasonography in Evaluation of Undetermined Etiology of Bile Ducts Dilation in Imaging

Aim: The aim is to determine the role of endoscopic ultrasonography in assessment of etiological diagnosis of bile ducts dilation when conventional imaging is inconclusive. Background Endoscopic ultrasonography (EUS) is an effective and primordial procedure in exploration of abnormalities of biliopancreatic junction. However, its results depend of the operator expertise, and its availability is currently insufficient in our regions. Methods: This is a retrospective descriptive study conducted from January 2008to May2019, including 42 patients with intra-and/or extra-hepatic bile duct dilatation without visible obstacle on imaging. TODANI classification was considered for common bile duct (CBD) cystic dilations. Statistical analysis was performed by SPSS software version24.0. Results: We enrolled 42patients responding to inclusion criteria in the study, which represented 10.18% of all indications of EUS. The mean age of our patients was 59.05±13.11 years, with a female predominance. Endoscopic findings showed a normal papilla in 92, 9%. EUS showed a dilated CBD in 66.8% of cases, she has allowed to make the diagnosis of a cystic dilation of CBD in 52,4%, predominated by type Ia and Ib in 45,2% and 4.8% respectively, of ampulloma in 4.8% (n = 2), papillomatosis of the bile ducts in 2.4% (n = 1), one case of pancreatic head tumor (2,4%), and choledocholithiasis in 4.8% (n = 2). By against EUS showed no expansion in 33.3% (n = 14). Conclusion: Our study confirms the prominent place of EUS in etiological profile of bile ducts dilatations when imaging is inconclusive.

Endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging for the diagnostic value of early colorectal cancer

Objective To investigate the diagnostic value of endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging (NBI-ME) in the diagnosis of early colorectal cancer. Methods A total of 187 patients with early colorectal cancer who were treated in Cancer Hospital Chinese Academy Medical Sciences and Peking Union Medical College from January 2015 to December 2017 were retrospectively analyzed. The patients were examined with NBI-ME along with endoscopic ultrasonography before endoscopic or surgical treatment, and the depth of invasion was judged. Finally, postoperative pathology was taken as the gold standard to evaluate the value of endoscopic ultrasonography combined with NBI-ME in the diagnosis of early colorectal cancer. Results The histopathological results were treated as the golden standard. The diagnostic accuracy rate of endoscopic ultrasonography and endoscopic ultrasonography combined with NBI-ME in 187 patients with early colorectal cancer was 84.0 % (157/187), 92.5 % (173/187) respectively. Overall accuracy rate of the invasive depth of NBI-ME in the patients with early colorectal cancer was 87.2 % (166/187). Sensitivity of endoscopic ultrasonography combined with NBI-ME to Tm, Tsm1 and ≥Tsm2 in early colorectal cancer pathological tissues was 92.4 %, 90.4 %, 93.3 % respectively, and the corresponding specificity was 93.9 %, 90.1 %, 90.9 % respectively. The diagnostic accuracy rate of endoscopic ultrasonography combined with NBI-ME was higher than that of endoscopic ultrasonography, and there was a significant difference (χ 2 = 6.594, P = 0.010 2). Conclusion Endoscopic ultrasonography combined with NBI-ME has a high accuracy rate for evaluating the depth of invasion in early colorectal cancer, which contributes to a good application value for preoperative evaluation of early colorectal cancer. Key words: Colorectal neoplasms; Early diagnosis; Endoscopic ultrasonography; Magnifying endoscopy; Narrow band imaging

Diagnostic value of endoscopic ultrasonography in staging of rectal cancer

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC). Methods From January 2015 to January 2017, the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed. Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases). The preoperative staging by EUS and postoperative pathological staging of two groups were compared. Kappa test was performed for statistical analysis. Results Compared with postoperative pathologic diagnosis, the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9% (127/155), and the accuracy rates in the diagnosis of Tis, T1, T2, T3 and T4 were 3/4, 11/13, 82.1%(32/39), 91.1%(41/45) and 74.1%(40/54), respectively, with a good consistency (kappa=0.751, P<0.01). However, the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7% (17/49), and the accuracy rates in the diagnosis of T2, T3 and T4 were 1/13, 2/7 and 14/16, respectively, with a poor consistency (kappa=0.107, P=0.850). Compared with postoperative pathologic diagnosis, the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3% (109/155), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7% (24/59) and 88.5% (85/96), respectively, with a poor consistency (kappa=0.317, P<0.01). The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0% (25/49), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6% (20/38), respectively, with a poor consistency (kappa=0.014, P=0.911). Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC, which may be helpful for determining clinical treatment strategy. However, for patients received CRT treatment, EUS has a limited value in diagnosing and staging the tumor. Key words: Rectal neoplasms; Endosonography; Neoplasm staging; Diagnosis

Diagnostic value of endoscopic ultrasonography on invasive depth of early esophageal cancer: a meta-analysis

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) on preoperative invasive depth of early esophageal cancer. Methods A systematic retrieval was performed in PubMed, CNKI and Wangfang databases. Studies on diagnosis of EUS on invasion depth or T1a/T1b stage of early esophageal cancer were retrieved, and related literatures were selected for meta-analysis based on inclusion criteria. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic advantage were calculated, and the receiver operating characteristic curve was drawn to calculate the area under the curve (AUC). Results A total of 20 articles with 1 336 cases were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC of EUS for T1m staging of early esophageal cancer were 0.86(95%CI: 0.83-0.88), 0.81(95%CI: 0.78-0.85), 4.92(95%CI: 3.02-8.00), 0.19(95%CI: 0.14-0.27), 32.54(95%CI: 15.52-68.25) and 0.923, respectively. For T1sm staging, these results were 0.81(95%CI: 0.78-0.85), 0.86(95%CI: 0.83-0.88), 5.17(95%CI: 3.66-7.32), 0.20(95%CI: 0.13-0.33), 32.02(95%CI: 15.31-66.99) and 0.922, respectively. Conclusion The diagnostic value of EUS is good for early esophageal cancer, and it has a relatively high sensitivity, specificity and AUC for the T1m and T1sm staging. Key words: Endoscopic ultrasonography; Early esophageal carcinoma; Depth; Meta-analysis

Limitations of endoscopic ultrasonography in the diagnosis of esophageal submucosal tumor

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS) for esophageal submucosal tumor (SMT). Methods Clinical data of 388 patients with esophageal SMT, who underwent EUS and endoscopic treatment in Tianjin Medical University General Hospital were collected from May 2010 to September 2016. The golden standard for the origin of esophageal SMT was the diagnosis during endoscopic treatment, and the golden standard of pathological type was the combination of postoperative pathological and immunohistochemical findings. The diagnostic accuracy of EUS for esophageal SMT was evaluated. Results The conventional endoscopy revealed that 31.70% (123/388) and 43.81% (170/388) esophageal SMTs were located in the middle and lower segments of esophagus, respectively. The diagnostic consistency of EUS for the origin of lesion was 71.51% (251/351), while the diagnostic consistency of EUS for lesion originated from the muscularis mucosae, submucosa and muscularis propria layer was 92.90% (170/183), 34.38% (11/32), and 51.47% (70/136), respectively. The diagnostic consistency of EUS for the type of lesion was 81.00% (260/321), while the diagnostic consistency of leiomyoma, esophageal cyst, and lipoma were 88.42% (252/285), 14.81% (4/27), and 80.00% (4/5), respectively. Conclusion EUS can preliminarily diagnose the origin and pathological type of esophageal SMT, but there are limitations on the diagnosis of uncommon lesions, which need combination of pathological and immunohistochemical findings. Key words: Endoscopic ultrasonography; Esophageal neoplasms, submucosal; Diagnosis; Accordance rate

Diagnostic value of endoscopic ultrasonography for staging of early gastric cancer

Objective To analyze the diagnostic value of endoscopic ultrasonography (EUS) for staging of early gastric cancer(EGC) and its influential factors. Methods Clinical information of 120 EGC patients admitted from February 2009 to January 2016 was reviewed. Diagnostic accuracy and the influencing factors of EUS for the invasive depth were analyzed by comparing the results of preoperative EUS and the pathology. Results Thirty-six patients were over-staged by EUS, and 10 patients were under-staged among 120 EGC patients. The accuracy, sensitivity, specificity of EUS for the submucosal invasion were 61.67%(74/120), 58.33%(14/24), 62.50%(60/96) respectively. The accuracy, sensitivity and specificity for protruded EGCs (Type I) diagnosis were 74.36%(29/39), 50.00%(6/12), 85.19%(23/27) respectively; these three variables were 59.02%(36/61), 83.33%(5/6), 56.36%(31/55) respectively for flat EGCs(Type Ⅱ), and 45.00%(9/20), 50.00%(3/6), 42.86%(6/14)respectively for excavated EGCs(Type Ⅲ). The univariate factor results showed that differentiated degree, location and endoscopic morphology of the tumor were possible influential factors for over-stage. Multivariate factor results showed that flat type (OR=3.667, 95%CI: 1.086-12.386, P<0.05)and excavated type(OR=6.552, 95%CI: 1.421-30.218, P<0.05) were independent risk factors. Gender, age and tumor maximum diameter were not factors influencing the diagnostic accuracy of EUS. Conclusion The EUS shows higher clinical value for diagnosing the invasive depth in EGC. Tumor differentiated degree, location and endoscopic morphology may be the influencing factors for diagnostic accuracy of EUS. Flat type and excavated type may lead to over-staging. Key words: Endoscopic ultrasonography; Early gastric cancer; Neoplasm stage; Risk factors

Endoscopic ultrasonography for preoperative staging of esophageal carcinoma

Objective: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative staging of esophageal carcinoma (EC).Material and methods: A total of 86 surgical patients with EC who were confirmed by endoscopy and biopsy underwent preoperative TN staging with EUS examination. The EUS findings were compared with surgical pathologic results.Results: The accuracy of EUS in T and N staging of EC was 82.6% and 84.9%, respectively. While determining whether EC invades the muscularis propria or outer membrane, EUS had the favorable sensitivity, specificity, positive predictive value and negative predictive value. The short-axis diameter of lymph nodes of 5mm had high sensitivity and negative predictive value to determine malignance with low specificity and positive predictive value. The short-axis diameter of 10mm presented the satisfactory sensitivity, specificity, positive predictive value and negative predictive value.Conclusion: EUS can accurately determine the TN staging of EC and provide a reliable basis for the treatment of EC.

The diagnostic value of endoscopic ultrasonography guided fine needle aspiration for occupying pancreatic lesions

Objective To evaluate safety and efficacy of EUS-FNA for occupying pancreatic lesions. Methods Data of 62 patients with occupying pancreatic lesions, who underwent EUS-FNA between June 2011 and June 2014, were analyzed for completion and complications, with surgery and clinical follow-up as the golden standard. Accuracy, sensitivity and specificity of EUS-FNA were calculated. Results A total of 62 patients with pancreatic lesions successfully underwent EUS-FNA and median puncture number was 4.2(3 to 8). Success rate of puncture was 100% and sampling satisfaction rate was 90.3%(56/62). No complications such as fever, infection, bleeding, perforation, severe pancreatitis or death were found. With the final diagnosis as the golden standard(39 malignant lesions and 23 benign lesions), overall diagnostic accuracy of EUS-FNA was 88.7%(55/62). The cytology diagnostic accuracy was 69.4%(43/62), significantly higher than that of the tissue pathology of 30.6%(19/62, P<0.01). Sensitivity and specificity of the procedure were 87.2%(34/39) and 91.3%(21/23) respectively. Conclusion EUS-FNA is an effective and safe procedure in diagnosis of occupying pancreatic lesions. Key words: Ultrasonography; Pancreatic diseases; Cytopathology; Histopathology; Fine needle aspiration

The diagnostic value of endoscopic ultrasonography for pancreatic neuroendocrine tumors

Objective To study the diagnostic value of endoscopic ultrasonography(EUS)for pancreatic neuroendocrine tumors (pNETs) by comparing EUS with computed tomography (CT), ultrasonography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT). Methods Data of 70 pNETs cases (a total of 77 lesions) confirmed by pathological diagnosis from July 2012 to March 2016 in Shanghai Cancer Center of the Fudan University were retrospectively studied. Among the cases, 53 cases (a total of 60 lesions) were confirmed by surgical pathology and their results of EUS, abdominal ultrasonography, CT, MRI and PET/CT were compared before surgery. Results A total of 76 lesions were detected by EUS, in which 32 lesions less than 2 cm were tested by HI ZOOM high definition amplification, qualified elastography images of 49 lesions were obtained, 42 solid lesions or solid components were also tested by Fine Flow, and 6 cases were tested by 3D imaging. Diagnostic rates of lesions by EUS, ultrasonography, CT, MRI and PET/CT were 98.33% (59/60), 61.11%(33/54), 89.47%(51/57), 76.00%(19/25) and 78.38%(29/37), respectively. For lesions less than 2 cm, diagnostic rates by these examinations were 96.30% (26/27), 47.83%(11/23), 76.00%(19/25), 54.55%(6/11) and 58.82%(10/17), respectively. Accuracy rates of EUS, ultrasonography, CT, MRI and PET/CT in the location of these lesions were 91.67%(55/60), 51.85%(28/54), 80.70%(46/57), 72.00%(18/25) and 75.68% (28/37), respectively. Conclusion Combined with Fine Flow, HI ZOOM high definition amplification and elastography, EUS is superior to standard imaging for pNETs, especially for lesions less than 2 cm. Key words: Endoscopic ultrasonography; Diagnosis; Pancreatic neuroendocrine tumors

Evaluation of preoperative endoscopic ultrasonography for diagnostic and therapeutic decision making in superficial gastric cancers

Objective To study the value of endoscopic ultrasonography (EUS) for diagnostic and therapeutic decision making in superficial gastric cancers. Methods In the period between January 2006 and December 2014, 77 patients diagnosed as having gastric cancers pathologically on biopsies who underwent EUS prior to therapy were reviewed. All lesions were resected either endoscopically or surgically. Final pathology was achieved in 83 lesions, including 72 early gastric cancers(EGC) and 11 advanced gastric cancers. Diagnostic value of EUS was evaluated by sensitivity, specificity and diagnostic accuracy, with the pathology of the resected specimen as the golden standard. Risk factors for EUS diagnosis were investigated by multivariable analysis. Results The sensitivity, specificity and diagnostic accuracy of EUS for EGC were 91.7%(66/72), 81.8%(9/11) and 90.4%(75/83), respectively. The diagnostic accuracy for mucosal cancer and submucosal cancer was 66.7%(48/72), and positive predictive value was 91.3%(42/46). Logistic multivariable analysis showed independent factors of EUS mis-staging included ulcers (OR=7.513, 95%CI: 1.735-32.541, P<0.05) and undifferentiated carcinoma (OR=8.194, 95%CI: 1.602-41.903, P<0.05). Conclusion EUS has a high diagnostic accuracy of early gastric cancers. Endoscopic resection could be considered for those mucosal lesions reported by EUS. But for those submucosal lesions by EUS, endoscopic manifestations are needed for therapeutic decisions. Key words: Endoscopic ultrasonography; Superficial gastric cancer; Depth of invasion; Impact factor; Therapeutic decision

Accuracy of endoscopic ultrasonography for evaluating minimal submucosal invasion of early gastrointestinal tumor

Objective To explore the diagnostic value of endoscopic ultrasonography (EUS) for the minimal submucosal invasion of early gastrointestinal tumor. Methods A total of 242 patients with early gastrointestinal tumor, who underwent endoscopic submucosal dissection, were retrospectively analyzed. The accuracy of EUS diagnosis was calculated based on postoperative histopathological findings as the golden standard, and influencing factors were also analyzed. Results Overall diagnostic accuracy of EUS for submucosal invasion of early gastrointestinal tumors was 72.3% (175/242), with an overstaging rate of 21.5%(52/242) and an understaging rate of 6.2%(15/242). Tumor size (P=0.018) and location (P=0.005) had significant effects on the diagnostic accuracy of the minimal submucosal invasion of early gastrointestinal tumor by EUS. The overstaging rate in the lesion length of diameter>3 cm was higher than those of 3 cm or less[27.0% (33/122)VS 15.8% (19/120), P=0.807], the overstaging rates of early colonrectal and gastric cancer were also significantly higher than the understaging rate[Colonrectum: 12.2% (9/74) VS 2.7% (2/74), P=0.028; Stomach: 26.9% (28/104) VS 2.9% (3/104), P=0.000]. Conclusion Endoscopic ultrasonography is of diagnostic value for the invasion depth of early cancer in gastrointestinal tract. However, precaution should be taken in large lesions and the tendency of overstaging in gastrointestinal tract. Key words: Endoscopic ultrasonography; Submucosal invasion; Early gastrointestinal tumor

The diagnostic value of endoscopic ultrasonography and contrast-enhanced harmonic endoscopic ultrasonography in gastrointestinal stromal tumors.

Objective:To evaluate the diagnostic value of endoscopic ultrasonography (EUS) and contrast-enhanced harmonic (CEH) EUS in patients with gastrointestinal stromal tumors (GISTs).Patients and Methods:About 19 patients with suspected GISTs underwent EUS and CEH-EUS before tumor resection. The malignant potential was assessed according to the modified Fletcher classification system. Patients were divided into lower (Group I) and higher (Group II) malignant potential group. The clinical characteristics and EUS/CEH-EUS features were compared between two groups.Results:The tumor size in Group II was significantly larger than that in Group I (14.6 ± 5.8 mm vs. 32.1 ± 8.4 mm, P < 0.05). Heterogeneous echogenicity was observed in 4 (4/8) cases in Group II and none in Group I (P < 0.05). Irregular intratumoral vessels were detected in 6 cases in Group II and none in Group I (P < 0.05). The sensitivity and specificity of irregular vessel detection for discriminating higher from lower malignant potential GISTs were 75% and 100%, respectively. The positive predictive value and negative predictive value of detection of irregular vessels to high malignant potential GISTs were 33% and 100%, respectively.Conclusion:Detection of irregular intratumoral vessels can predict higher malignant potential before tumor resection. The tumor size and echogenicity are assistant factors for malignant potential assessment. Endoscopic resection is an efficacious treatment with good security for appropriate patients.

Comparative Study between Endoscopic Ultrasonography and Transabdominal Ultrasonography in the Assessment of Pancreatobiliary Diseases (with Literatures Review)

Background: Endoscopic ultrasonography (EUS) and transadominal ultrasonography (TUS) are two imaging investigations which can be used to assess pancreatobiliary status, although both of these imaging techniques are operator and machine dependent, but they have different sensitivity and specificity in detecting pancreatobiliary diseases. Objective: To compare the diagnostic value of EUS versus TUS in the assessment of pancreatobiliary diseases. Patients and Methods: This study was conducted in KCGH (Kurdistan Center for Gastroenterology and Hepatology) in Sulaimani city. Iraqi Kurdistan; the duration of study was 14 months and conducted after approval of Iraqi board ethical committee. One hundred cases were enrolled in the study: 52 of them were females and 48 were males; their ages ranged between 16 - 90 years; informed consent was taken from all patients; all patients underwent proper clinical evaluation; TUS, EUS and Oesophagogastroduodenoscopy (OGD), and in some of them (25 patients) Endoscopic Retrograde Cholangiopancreatography (ERCP), CT scan of abdomen and laboratory investigations were done. Results: EUS detected more cases with common bile duct (CBD) dilatation, CBD stones and pancreatic space occupying lesion (SOL) than TUS, but the differences in the results were not statistically significant. Also EUS detected more cases of intra-abdominal lymph nodes (LNs) and ampullary/peri-ampullary neoplasms than TUS and the differences in the results were statistically significant. Conclusions: Eus is more sensitive than TUS in diagnosing CBD dilatation; it has higher sensitivity than TUS in suspected pancreatobiliary neoplasms; furthermore, EUS can be used for staging and resectability assessment of pancreatobiliary neoplasia.