Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study

Xiaojia Hou, Zhendong Jin, Can Xu, Minmin Zhang, Jianwei Zhu, Fei Jiang, Zhaoshen Li, Xiaojia Hou, Zhendong Jin, Can Xu, Minmin Zhang, Jianwei Zhu, Fei Jiang, Zhaoshen Li

Abstract

Background: The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis.

Aims: To evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions.

Methods: Patients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups.

Results: Operating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%).

Conclusion: Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Representative example of a pancreatic…
Fig 1. Representative example of a pancreatic adenocarcinoma with hypoenhancement.
Conventional endoscopic ultrasonography (left) shows a heterogeneous hypoechoic area without a clear margin at the pancreas head. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that most of the area is hypovascular and the remaining area is hypervascular compared to the surrounding tissue. An irregular margin is visible.
Fig 2. Representative example of focal pancreatitis…
Fig 2. Representative example of focal pancreatitis with hyperenhancement.
Conventional endoscopic ultrasonography (left) shows a slightly hypoechoic area without a clear margin at the pancreas head. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that enhancement in this area is higher than in the surrounding tissue, and a margin is clearly visible.
Fig 3. Representative example of a pancreatic…
Fig 3. Representative example of a pancreatic neuroendocrine tumor with hyperenhancement.
Conventional endoscopic ultrasonography (left) shows a hypoechoic mass with a clear margin at the pancreas body. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that the mass has a hyperenhancement compared to the surrounding tissue.

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