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

Medicine, 2018

Evaluating the role of endoscopic ultrasound (EUS) elastography and strain ratio in differentiation between malignant and benign pancreatic lesions.Three hundred twenty-five patients with solid pancreatic lesions were enrolled in this prospective study from 2014 to 2017. EUS real-time elastography scoring and strain ratio were done to all patients and compared to the final diagnosis to assess its sensitivity, specificity, positive and negative predictive values (PPV and NPV) in differentiating malignant from benign lesions.A cut-off value of 4.2 we had sensitivity of 95%, specificity of 63%, PPV of 89%, NPV of 81%, and accuracy of 87%. Another cut-off value of 10.9 showed a sensitivity of 75%, specificity of 88%, PPV of 95%, NPV of 54%, and accuracy of 79%. Adding the elastography to the better cut-off value gave a sensitivity of 97%, specificity of 63%, PPV of 89%, NPV of 88%, and accuracy of 89%.Real-time elastography and strain ration are valuable in differentiating malignant fro...

Pancreatology, 2015

Background Endoscopic ultrasound (EUS) elastography is a novel method for visualization of tissue elasticity modulus during a conventional EUS examination. The reported yield of EUS elastography for the differentiation of benign and malignant pancreatic masses has shown variable results. The objective of this study was to assess the accuracy of EUS elastography by pooling data of available trials. Methods The Medline, PubMed, Embase, and Cochrane Central Trials databases were used to retrieve all the studies that assessed the diagnostic accuracy of EUS elastography for the differentiation of benign and malignant pancreatic masses. Pooling was carried out using a fixed-effect model when significant heterogeneity was not present; otherwise, the random-effect model was used. If there were less than four studies using the same diagnostic standard, forest plots were constructed without pooling. Results In six studies using the qualitative color pattern as the diagnostic standard, the sensitivity was 99% (95% confidence interval 98-100%) and the specificity was 74% (95% confidence interval 65-82%). The area under the curve under the summary receiver-operating characteristic was 0.9624. In three studies using the quantitative hue histogram value as the diagnostic standard, the sensitivity was 85-93% and the specificity was 64-76%. Conclusion EUS elastography is a promising noninvasive technique for the differentiation of pancreatic masses with a high sensitivity, and may prove to be a valuable complementary method to EUS-FNA.

World Journal of Gastroenterology, 2017

Author contributions: Okasha H is the main endosongrapher who performed all the cases and participated in the study design; Elkholy S, Mahdy RE and El-Sayed R participated in Manuscript writing and data analysis; Wifi MN, El-Nady M, El-Dayem WA and Radwan MI participated in design and oversight of the study; El-Nabawi W, Farag A and El-sherif Y participated in design of the study and data collection; Salman A, El-Sherbiny M and El-Mazny A were involved with data collection, and follow up of the patients; Al-Gemeie E is the main histopathologist who performed histopathological analysis for the specimens; all the above mentioned authors have read and approved the final manuscript.

Scandinavian Journal of Gastroenterology, 2014

Objectives. The aim of this study was to evaluate the diagnostic potential of strain assessment in solid focal pancreatic lesions using real-time elastography in combination with endoscopic ultrasonography (EUS). Material and methods. Forty-eight solid focal pancreatic lesions in 39 patients were included prospectively over a 3-year period and studied by EUS with real-time elastography (EUS-RTE). Lesions previously described as cystic by CT were not included. Distribution patterns of tissue strain were assessed using strain ratio (SR) measurements, continuous visual analog scale (VAS), and a visual categorical score (VCS), based on color coding of relative strain. Final diagnosis was based on histopathology, fine-needle aspiration cytology, and/or follow-up for ‡6 months. Results. The 48 lesions included 11 adenocarcinomas, 7 malignant neuroendocrine tumors (NETs), 11 benign or indeterminate NETs, 8 focal pancreatic lesions, 2 microcystic adenomas, and 9 other benign lesions. Malignant lesions had significantly higher median SR (7.05 vs. 1.56) and VAS scores (93.0 vs. 63.5) than benign lesions. A receiver operation characteristic curve analysis showed sensitivity of 67% and specificity of 71%, when using SR = 4.4 as a cutoff for malignancy. The highest SR values were found in two benign microcystic adenomas. Conclusions. EUS-RTE with SR measurements and VAS evaluation demonstrated a significant strain difference between benign and malignant lesions. However, the variation within the entities was substantial and some benign lesions presented with low strain. Benign lesions were generally characterized by a strain similar to reference tissue, whereas malignant lesions were harder. The recorded strain pattern in individual lesions must be interpreted with caution.

Endoscopic Ultrasound, 2017

East African Medical Journal, 2015

Objective: To evaluate the accuracy of elastography in differentiating benign from malignant pancreatic masses for patients. Design: A prospective, consecutive, study Setting: Kasr Alini hospital department of internal Medicine , university of Cairo, Egypt. Subjects: Thirty patients had a solid-appearing pancreatic mass at conventional ultrasound, EUS and CT abdomen were included in the study. Results: A total of 30 patients were included in the study. The age of the Patients ranged between 38 and 70 years with a mean value of 54± 8.6 Years. The study included 22 (73.3%) males and eight (26.7%) females. The mean size of pancreatic masses was 35.6 ± 11.8 mm. The final diagnosis were pancreatic adenocarcinoma (n =25) papillary adenocarcinoma (n =1), papillary adenoma (n =2) and chronic pancreatitis (n =2). The strain ratio was significantly higher among patient with pancreatic malignant tumour compare with those with inflammatory masses. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for elastograpgy to Differentiate malignant from benign pancreatic masses were: 88%, 80%, 95.6%, 57.14% and 86% respectively (area under receiver operating curve 0 .974). Conclusion: EUS elastography is a useful tool for differentiating malignant from benign pancreatic masses through objective evaluation of tissue stiffness.

World journal of gastroenterology : WJG, 2015

To investigate the accuracy of the strain histogram endoscopic ultrasound (EUS)-based method for the diagnostic differentiation of patients with pancreatic masses. In a prospective single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms (SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1 (over the mass) and Mode 2 (over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery (58 patients), and a...

Euroasian Journal of Hepato-Gastroenterology, 2023

Background: 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.

Endoscopic Ultrasound, 2015

Background and Objectives: Previous reports assessing the reproducibility of endoscopic ultrasound elastography (EUS-E) in evaluation of solid pancreatic lesions (SPL) involved only experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of EUS-E in the evaluation of SPL by endoscopists with different levels of experience in EUS and EUS-E.

Journal of Health Sciences and Medicine, 2020

Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single centre during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/42 (63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) ha...