Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study

Marc Giovannini, Botelberge Thomas, Bories Erwan, Pesenti Christian, Caillol Fabrice, Esterni Benjamin, Monges Geneviève, Arcidiacono Paolo, Deprez Pierre, Yeung Robert, Schimdt Walter, Schrader Hanz, Szymanski Carl, Dietrich Christoph, Eisendrath Pierre, Van Laethem Jean-Luc, Devière Jacques, Vilmann Peter, Saftoiu Andrian, Marc Giovannini, Botelberge Thomas, Bories Erwan, Pesenti Christian, Caillol Fabrice, Esterni Benjamin, Monges Geneviève, Arcidiacono Paolo, Deprez Pierre, Yeung Robert, Schimdt Walter, Schrader Hanz, Szymanski Carl, Dietrich Christoph, Eisendrath Pierre, Van Laethem Jean-Luc, Devière Jacques, Vilmann Peter, Saftoiu Andrian

Abstract

Aim: To evaluate the ability of endoscopic ultrasound (EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.

Methods: A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass (n = 121) or lymph node (n = 101). The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration (EUS-FNA) and/or by surgical pathology. An interobserver study was performed.

Results: The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.

Conclusion: EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.

Figures

Figure 1
Figure 1
Elastographic image showing homogenous soft tissue corresponding to normal tissue.
Figure 2
Figure 2
Elastographic image. A: Heterogenous soft tissue corresponding to fibrosis (benign nodule in patient who had an acute pancreatitis 2 mo before); B: Heterogenous soft tissue corresponding to inflammatory tissue (benign lymph node).
Figure 3
Figure 3
Elastographic image showing mixed hard and soft tissue (“honeycombed pattern”) making the interpretation difficult.
Figure 4
Figure 4
Elastographic image showing mainly hard tissue with a small soft central area corresponding to a malignant hypervascularized lesion (pancreatic neuroendocrine tumor).
Figure 5
Figure 5
Elastographic image showing mainly hard tissue with areas of heterogenous soft tissue corresponding to an advanced malignant lesion with necrotic areas (pancreatic adenocarcinoma).
Figure 6
Figure 6
Elastography score.
Figure 7
Figure 7
Pancreatic masses: elastography score and final histology.
Figure 8
Figure 8
Lymph nodes: elastography score and final histology.

Source: PubMed

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