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Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine

引用

World Journal of Clinical Cases 2019年第1期7卷 19-27页

作者： Klaus Kannengiesser Reiner Mahlke frauke petersen Anja Peters Torsten Kucharzik Christian Maaser Department of General Internal Medicine and Gastroenterology University Teaching Hospital Lueneburg Department of Pathology University Teaching Hospital Lueneburg

BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative *** To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative *** Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively. Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation, quantitative analysis was performed later on. Samples from fine needle aspiration(EUS-FNA) or surgical specimen served as gold *** CEH-EUS showed 39 hypoenhanced lesions, 3 non-enhanced and 13 hyperenhanced lesions. Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%, while other parameters such as arrival time, time to peak or area under the curve did not show additional value. 34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma; of the hyperenhanced lesions 4 were inflammatory, 3 neuroendocrine carcinomas, 1 lymphoma, 1 insulinoma and 4 metastases(2 of renal cell carcinoma, 2 of lung cancer). Non-enhanced lesions showed up as necroses. Sensitivity for the detection of pancreatic adenocarcinoma was 100%,specificity 87.2% for hypoenhancement alone; in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma(sensitivity and specificity 100%, PPV and NPV for adenocarcinoma 100%).CONCLUSION This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma. Additional quantitative analysis of perfusion parameters does not add diagnostic yield. In case of the various hyperenhanced pancreatic lesions in our data set, histologic samp

关键词： Endoscopic ultrasound Contrast enhanced endoscopic ultrasound Pancreatic adenocarcinoma Neuroendocrine carcinoma Pancreatic metastases Lymphoma

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