Quantitative Endoscopic Ultrasound Elastography Research Articles

Role of endoscopic ultrasound elastography in differential diagnosis of pancreatic solid masses

Introduction: Endoscopic ultrasound (EUS) elastography is another technique that measures the stiffness of tissue and adds more diagnostic value to EUS.Objective: This study aimed to assess the ability of qualitative and quantitative EUS elastography in differentiating malignant from benign solid pancreatic masses.Methods: This 2-year cross-sectional study enrolled 80 patients with solid pancreatic masses in the department of endoscopy in Alassad University Hospital who underwent conventional and elastography-assisted EUS and then followed for pathology through EUS-guided or CT-guided biopsy or surgery.Results: Qualitative elastography using a 5-point scoring system was able to recognize malignant pathology (obtained by EUS-guided biopsy, CT-guided biopsy, or surgery) with a sensitivity, specificity, and accuracy rates of 100%, 28.6%, and 81.3%, respectively. A quantitative method using hue histogram had a sensitivity of 71.2%–86.4% and specificity of 71.4%–81% with the best accuracy for histogram mean ratio (area under the curve, 0.867).Conclusion: EUS elastography is a simple and good alternative method in differentiating malignant from benign pancreatic solid masses.

Efficacy of Endoscopic Ultrasound Elastography in Differential Diagnosis of Gastrointestinal Stromal Tumor Versus Gastrointestinal Leiomyoma.

BackgroundThe diagnostic efficacy of endoscopic ultrasound (EUS) elastography for alimentary tract diseases remains uncertain. The aim of this study was to evaluate the utility of EUS elastography in differential diagnosis between the 2 most common subepithelium tumors of the digestive tract – gastrointestinal stromal tumors (GISTs) and gastrointestinal leiomyomas (GILs) – which cannot be differentiated by conventional EUS imaging.Material/MethodsElectronic records were retrospectively reviewed from Jan 2015 to Jul 2019. Patients accepting EUS elastography with histopathological diagnosis of GISTs or GILs were included. The images of EUS elastography were analyzed by hue histogram in Photoshop. Hue values of RGB, R, G, and B channels of each group were acquired. We used the t test, ROC curve analysis, and binary logistic regression analysis for data post-processing.ResultsWe included 47 patients with GISTs and 14 with GILs. The mean±standard deviations (SD) of hue values were 20.25±0.72, −0.79±0.78, 20.79±1.68, 39.72±1.30 for GISTs and 20.80±0.46, 1.80±1.05, 28.39±2.15, and 31.95±2.60 for GILs of RGB, R, G, and B channels, respectively. The t test showed statistically significant differences in mean hue values between GISTs and GILs in B and G channels, but not in RGB and R channels. The area under the ROC curve combining B and G values was 0.723. Binary logistic regression analysis suggested no statistically significant difference in ability to differentiate between GISTs and GILs with B and G values (P>0.05).ConclusionsThere was insufficient evidence to support the application of quantitative EUS elastography for differential diagnosis of GISTs and GILs in this study.

Diagnostic efficacy of quantitative endoscopic ultrasound elastography for differentiating pancreatic disease.

Endoscopic ultrasound elastography (EUS-EG) constitutes a novel imaging procedure that allows for the quantification of tissue stiffness with high degrees of accuracy in pancreatic disease. However, the optimal cut-off and reference strain ratio (SR) value of quantitative EUS-EG for differential diagnosis in patients with pancreatic disease remains unclear. This study aimed to clarify these values of normal pancreas, chronic pancreatitis, or pancreatic cancer in an Asian population. Between December 2014 and November 2015, 398 patients without pancreatic disease, 67 patients with chronic pancreatitis, and 90 patients with pancreatic cancer who underwent EUS were enrolled prospectively. Elastographic evaluation was measured using the quotient B/A (SR value). The mean SR was 3.78±1.35 for normal pancreas, 8.21±5.16 for chronic pancreatitis, and 21.80±12.23 for pancreatic cancer (P<0.001). The median SR was 15.14 for mass-forming pancreatitis and 18.00 for pancreatic cancer (P=0.024). The sensitivity, specificity, and accuracy of the SR were 71.6%, 75.2%, and 74.8%, respectively, for detecting chronic pancreatitis using a cut-off value of 5.62, and were 95.6%, 96.3%, and 96.2%, respectively, for detecting pancreatic cancer using a cut-off value of 8.86. We provided reference range SR values for normal pancreas, chronic pancreatitis, and pancreatic cancer, as well as an optimal cut-off value for chronic pancreatitis and pancreatic cancer diagnostic accuracy in an Asian population. Quantitative EUS-EG is a supplementary diagnostic method for identifying pancreatic disease.

Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors.

Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors.

Tu1666 Qualitative and Quantitative Endoscopic Ultrasound Elastography in Pancreatic Malignancies and Healthy Controls; a Prospective Study

Endoscopic ultrasound elastography (EUS-EG) is a technique for real-time assessment of tissue elasticity; there are 2 types: qualitative by color patterns and quantitative by determining strain ratio (SR).

Endoscopic ultrasound features of chronic pancreatitis: A pictorial review.

As endoscopic ultrasound (EUS) is the most sensitive imaging modality for diagnosing pancreatic disorders, it can demonstrate subtle alterations in the pancreatic parenchymal and ductal structure even before traditional imaging and functional testing demonstrate any abnormality. In spite of this fact and abundant literature, the exact role of EUS in the diagnosis of chronic pancreatitis (CP) is still not established. The EUS features to diagnose CP have evolved over a period from a pure qualitative approach to more advanced and complicated scoring systems incorporating multiple parenchymal and ductal EUS features. The rosemont criteria have attempted to define precisely each EUS criterion and thus have good inter-observer agreement. However, initial studies have failed to demonstrate any significant improvement in the inter-observer variability and further validation studies are needed to define the exact role of these criteria. The measurement of strain ratio using quantitative EUS elastography and thus allowing quantification of pancreatic fibrosis seems to be a promising new technique.

Pancreatic Cancer – Advanced EUS Imaging: Real-Time EUS Elastography

Endoscopic ultrasound (EUS) elastography was designed to offer supplemental information about the examined area in order to obtain a better characterization of tissue elasticity. The principle of the method implies that malignant structures are harder than benign ones. Quantitative EUS elastography assessment can be done using post-processing computed analysis. New ultrasound systems incorporate advanced real-time analysis software in order to offer a real-time value of the elasticity, thus eliminating the inherent human bias induced by inter- and intraobserver perception errors. Other new EUS procedures are currently available in order to increase the accuracy of the examination. The gold standard method for certitude in cancer diagnosis remains EUS fine-needle aspiration biopsy and the cytological examination of the aspirate. This article is part of an expert video encyclopedia.

Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: A meta‐analysis

Endoscopic ultrasound (EUS) elastography is not used for detection but rather for characterization of solid pancreatic masses. A meta-analysis was used to assess the accuracy of EUS elastography for identification of malignant pancreatic masses. PubMed, the Cochrane Library, and the ISI Web of Knowledge were searched. The studies relating to evaluation accuracy of qualitative or quantitative EUS elastography for identification of malignant pancreatic masses were collected. Language was limited to English. The sensitivity and specificity were used to examine the accuracy. Clinical utility was evaluated by likelihood ratio scattergram. A total of 10 studies including 893 pancreatic masses (646 malignant, 72.3%) were analyzed. The summary sensitivity and specificity for the diagnosis of malignant pancreatic masses were 0.98 (95% confidence interval [CI] 0.93-1.00) and 0.69 (95% CI 0.52-0.82) for qualitative EUS elastography, and 0.96 (95% CI 0.86-0.99) and 0.76 (95% CI 0.58-0.87) for quantitative EUS elastography, respectively. The hierarchical summary receiver operating characteristic curves were 0.94 and 0.93 for qualitative and quantitative EUS elastography. The accuracy of quantitative methods was similar to qualitative methods. The positive and negative likelihood ratios were 3.15 and 0.03 for qualitative EUS elastography, and 3.94 and 0.05 for quantitative EUS elastography, respectively. Both qualitative and quantitative methods were useful for exclusion of presence of malignant pancreatic masses and not for its confirmation. EUS elastography could be used as a good identification tool for benign and malignant pancreatic masses, with its good performance for exclusion of presence of malignant pancreatic masses.

Differential diagnosis of solid pancreatic masses by Quantitative Endoscopic Ultrasound Elastography (Q-EUS-E): A validation study

Differential diagnosis of solid pancreatic masses by Quantitative Endoscopic Ultrasound Elastography (Q-EUS-E): A validation study

Quantitative Endoscopic Ultrasound Elastography (Q-EUS-E) is an accurate method for the differential diagnosis of solid pancreatic masses: A validation study

Quantitative Endoscopic Ultrasound Elastography (Q-EUS-E) is an accurate method for the differential diagnosis of solid pancreatic masses: A validation study

Sa1193 Quantitative Endoscopic Ultrasound Elastography (Q-EUS-E) in the Differential Diagnosis of Solid Pancreatic Masses: A Validation Study

Endoscopic ultrasound (EUS) guided biopsy allows cytologic and/or histologic diagnosis of sub-mucosal lesions of the gastrointestinal tract (GIT). The diagnostic yield with fine needle aspiration (FNA), however, is often unsatisfactory (~30-40%). A newly developed Pro-Core needle (PCN) is able to obtain core tissue and may improve diagnostic yield. AIM: To compare the performance of two EUS guided biopsy needle systems, FNA versus PCN, in the evaluation of sub-mucosal lesions in the upper GIT. METHODS: Data related to patients referred for EUS and possible guided biopsy of sub-mucosal lesions in the upper GIT over 24 months were retrospectively reviewed. All specimens were prepared as cell-block for histo-cytological analysis. Measured outcomes were presence of diagnostic material, ability to perform immunohistochemistry (IHC), provision of a diagnosis, and complication. RESULTS: Of 84 patients who had EUS evaluation of an upper GIT sub-mucosal lesion, 30 patients did not have biopsy (lipoma=14, duplication cysts=6, vascular compression=1 and no abnormality=9). EUS-guided biopsy were performed in 54 patients, using 19-22G FNA (n=34) and 22G PCN (n=20) system, to clarify the tissue diagnosis of a hypo-echoic submucosal mass. There were no differences in age (61.1±2.6 vs. 59.2±5.3 yrs), gender (13M:17F vs. 3M:8F), site (22gastric : 8duodenal : 4esophageal vs. 17gastric : 1duodenal : 2esophageal) or size (2.1±0.1 vs. 2.1±0.3 cm) of biopsied lesion between the FNA and PCN groups, respectively. Biopsy with PCN obtained significantly more diagnostic material than FNA, leading to a substantially higher diagnostic yield (18/20 vs. 14/34; P ,0.001). Of the 17 suspected spindle cell tumours from the PCN group, IHC study (c-kit stain) were successful in all cases and provided tissue confirmation of 10 leiomyomas and 7 gastrointestinal stromal tumours (GIST). In contrast, only 7/14 patients with FNA needle had sufficient material for additional IHC study (P=0.008, vs. PCN), confirming GIST in only 3/12 of suspected spindle cell tumours. Neither group had abdominal pain or clinical significant bleeding after the biopsy. CONCLUSIONS: EUS guided biopsy with 22G PCN has substantially higher histocytological yield than that with FNA needles (90% vs. 41%) and without any complication. PCN, therefore, should be the needle of choice for tissue acquisition of sub-mucosal lesions in the GIT.

OC-109 Utility of quantitative endoscopic ultrasound elastography (QEUSE) for the diagnosis of pancreatic malignancy: a large single-centre experience

IntroductionRecent data suggest that QEUSE, a novel technique that allows real-time quantification of tissue stiffness, can accurately differentiate benign from malignant solid pancreatic masses (area under the receiver operating curve...

Endoscopic ultrasound elastography.

Endoscopic ultrasound (EUS) is a reference technique for diagnosing and staging several different diseases. EUS-guided biopsies and fine needle aspirations are used to improve diagnostic performance of cases where a definitive diagnosis cannot be obtained through conventional EUS. However, EUS-guided tissue sampling requires experience and is associated with a low but not negligible risk of complications. EUS elastography is a non-invasive method that can be used in combination with conventional EUS and has the potential for improving the diagnostic accuracy and reducing the need for EUS-guided tissue sampling in several situations. Elastography measures tissue stiffness by evaluating changes in the EUS image before and after the application of slight pressure to the target tissue by the ultrasonography probe. Pathologic processes such as cancerization and fibrosis alter tissue elasticity and therefore induce changes in elastographic appearance. Qualitative elastography depicts tissue stiffness using different colors, whereas quantitative elastography renders numerical results expressed as a strain ratio or hue histogram mean. EUS elastography has been proven to differentiate between benign and malignant solid pancreatic masses, as well as between benign and malignant lymph nodes with a high accuracy. Studies have also demonstrated that the early changes of chronic pancreatitis can be distinguished from normal pancreatic tissues under EUS elastography. In this article, we review the technical aspects and current clinical applications of qualitative and quantitative EUS elastography and emphasize the potential additional indications that need to be evaluated in future clinical studies.

Endoscopic ultrasound elastography

Endoscopic ultrasound (EUS) is a reference technique for diagnosing and staging several different diseases. EUS-guided biopsies and fine needle aspirations are used to improve diagnostic performance of cases where a definitive diagnosis cannot be obtained through conventional EUS. However, EUS-guided tissue sampling requires experience and is associated with a low but not negligible risk of complications. EUS elastography is a non-invasive method that can be used in combination with conventional EUS and has the potential for improving the diagnostic accuracy and reducing the need for EUS-guided tissue sampling in several situations. Elastography measures tissue stiffness by evaluating changes in the EUS image before and after the application of slight pressure to the target tissue by the ultrasonography probe. Pathologic processes such as cancerization and fibrosis alter tissue elasticity and therefore induce changes in elastographic appearance. Qualitative elastography depicts tissue stiffness using different colors, whereas quantitative elastography renders numerical results expressed as a strain ratio or hue histogram mean. EUS elastography has been proven to differentiate between benign and malignant solid pancreatic masses, as well as between benign and malignant lymph nodes with a high accuracy. Studies have also demonstrated that the early changes of chronic pancreatitis can be distinguished from normal pancreatic tissues under EUS elastography. In this article, we review the technical aspects and current clinical applications of qualitative and quantitative EUS elastography and emphasize the potential additional indications that need to be evaluated in future clinical studies.

The Utility of Quantitative Endoscopic Ultrasound Elastography for the Diagnosis of Solid Pancreatic Masses

Introduction Recent data suggests that endoscopic ultrasound elastography, a novel technique that allows real-time quantification of tissue stiffness, can accurately differentiate benign from malignant solid pancreatic masses.1 External validation of the diagnostic utility of this technique has not been reported. Methods We carried out quantitative EUSE on 31 consecutive patients with EUS-proven solid pancreatic masses using the linear Hitachi EUB-7500. Multiple quantitative elastographic measurements of the mass lesion (A) and soft tissue references areas (B) were undertaken in each patient and the corresponding strain ratios (B/A) were calculated. Final diagnosis was based on EUS-fine needle aspiration cytology and/or resection specimen histology. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. Results The mean lesion size was 27.6 (SD 9.8) mm. The final diagnoses were pancreatic adenocarcinoma (n=24), inflammatory mass (n=5) and neuroendocrine tumour (n=2). Both strain ratio and pancreatic mass elasticity were significantly higher among patients with pancreatic malignant tumours compared with those with inflammatory masses. However, the sensitivity, specificity, accuracy and area under the receiver operating curve of EUSE for correctly diagnosing pancreatic malignancy in our cohort (table 1) were less favourable than those reported recently, with lower mean strain ratio (4.62 vs 6.04) and higher pancreatic mass elasticity cut-offs (0.28 vs 0.05) providing the highest accuracy. Conclusion Quantitative EUS elastography is a promising tool for the differential diagnosis of solid pancreatic masses although its accuracy in our experience has been less favourable than recently reported. Further assessment of the utility of this technique in other cohorts is warranted.

The utility of quantitative endoscopic ultrasound elastography for the diagnosis of solid pancreatic masses

IntroductionRecent data suggests that endoscopic ultrasound elastography, a novel technique that allows real-time quantification of tissue stiffness, can accurately differentiate benign from malignant solid pancreatic masses.1 External validation of the...

Quantitative Endoscopic Ultrasound Elastography

Quantitative Endoscopic Ultrasound Elastography

Quantitative Endoscopic Ultrasound Elastography: An Accurate Method for the Differentiation of Solid Pancreatic Masses

Qualitative endoscopic ultrasound (EUS) elastography is an accurate but subjective tool for the differential diagnosis of solid pancreatic masses. Second-generation EUS elastography allows quantitative analysis of tissue stiffness. We evaluated the accuracy of quantitative, second-generation EUS elastography in the differential diagnosis of solid pancreatic masses. The study included 86 consecutive patients who underwent EUS for the evaluation of solid pancreatic masses. EUS elastography was performed with the linear Pentax EUS and the Hitachi EUB900. Representative areas from the mass (A) and soft reference areas (B) were analyzed. The result of the elastographic evaluation was defined by the quotient B/A (strain ratio). Final diagnosis was based on histology of surgical specimens and cytology of EUS-fine-needle aspiration samples. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. The mean size of the pancreatic masses was 31.4 ± 12.3 mm. The final diagnoses were pancreatic adenocarcinoma (n = 49), inflammatory mass (n = 27), malignant neuroendocrine tumor (n = 6), metastatic oat-cell lung cancer (n = 2), pancreatic lymphoma (n = 1), and pancreatic solid pseudopapillary tumor (n = 1). The strain ratio was significantly higher among patients with pancreatic malignant tumors compared with those with inflammatory masses. The sensitivity and specificity of strain ratio for detecting pancreatic malignancies were 100% and 92.9%, respectively (area under the receiver operating curve, 0.983). Quantitative, second-generation EUS elastography is useful for differential diagnosis of solid pancreatic masses. It allows for a quantitative and objective evaluation of tissue stiffness, which indicates the malignant or benign nature of the pancreatic lesion.