A meta-analysis of contrast-enhanced harmonic endoscopic ultrasonography on differential diagnosis of pancreatic mass / 中华消化内镜杂志

Objective To estimate the value of contrast-enhanced harmonic endoscopic ultrasonography(CEH-EUS)on differential diagnosis of pancreatic mass. Methods Multiple Chinese and English databases were retrieved to selected relevant literature.The quality of literature was assessed,and the data were meta-analyzed using Metadisc 1.4 and STATA 14.0 software. Results A total of 16 researches with 1 352 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio,and diagnostic odds ratio was 93%(95%CI: 92%-95%), 84%(95%CI:80%-87%), 5.82(95%CI: 4.06-8.33), 0.08(95%CI: 0.06-0.10), and 77.33(95%CI: 52.37-114.17), respectively. The area under the summary receiver operating characteristic curve was 0.96(95%CI: 0.94-0.97). The results of subgroup analysis demonstrated that the number of cases, region, QUADAS scores, the diameter and type of mass,and the experience of diagnostician were not the source of heterogeneity.After 2 articles with larger bias were eliminated,the heterogeneity dropped to an acceptable range,and the pooled sensitivity,specificity,positive predictive value and negative predictive value had no significant change. All these suggested that the results of meta-analysis were reliable. Conclusion CEH-EUS has a high accuracy in differential diagnosis of pancreatic mass,and can be used as an effective diagnostic method.

Contrast Enhanced Harmonic Endoscopic Ultrasound: A Novel Approach for Diagnosis and Management of Gastrointestinal Stromal Tumors

The histologic analysis of gastrointestinal stromal tumors (GISTs) is a common method to detect the mitotic activity and to subsequently determine the risk of GISTs for malignancy. The potential false negative error due to inadequate yield of specimens and actual determination of malignancy risk requires analysis of the whole tumor. We aimed to assess the role of contrast enhanced endoscopic ultrasound (CE-EUS) in the management of GISTs. Two authors individually did review of English literatures to identify nine peer-reviewed original articles using keywords- contrast endoscopic ultrasound, GIST and submucosal tumor. Studies were heterogeneous in their aims looking either at differentiating submucosal lesions from GISTs, estimating malignant potential of GISTs with histologic correlation or studying the role of angiogenesis in malignant risk stratification. CE-EUS had moderate to high efficacy in differentiating GISTs from alternative submucosal tumors. CE-EUS had a higher sensitivity than EUS-guided fine needle aspiration, contrast computed tomography and Doppler EUS for detection of neo-vascularity within the GISTs. However, the evidence of abnormal angiogenesis within GIST as a prognostic factor needs further validation. CE-EUS is a non-invasive modality, which can help differentiate GISTs and provide valuable assessment of their perfusion patterns to allow better prediction of their malignant potential but more experience is needed.

Clinical Value of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Pancreatic and Gallbladder Masses

BACKGROUND/AIMS: Recent studies have revealed that contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is beneficial in the differential diagnosis of malignant neoplasms of the pancreas and gallbladder from benign masses, in terms of the evaluation of microvasculature and real-time perfusion. In this study, we aimed to prove the clinical value of CEH-EUS in the differential diagnosis of pancreatic and gallbladder masses by direct comparison with that of conventional EUS. METHODS: We reviewed the sonographic images and medical information of 471 patients who underwent conventional EUS and CEH-EUS for the diagnosis of pancreatic and gallbladder masses at a single medical center (Severance Hospital, Seoul, Korea) between March 2010 and March 2016. RESULTS: The enhancement pattern of CEH-EUS of the pancreatic solid masses showed higher sensitivity and specificity in differentiating pancreatic adenocarcinoma and neuroendocrine tumors (82.0% and 87.9% for pancreatic adenocarcinoma and 81.1% and 90.9% for neuroendocrine tumors, respectively), and the area under the receiver operating characteristic curves was higher than that of conventional EUS. The enhancement texture of CEH-EUS of the gallbladder masses showed a higher sensitivity in differentiating malignant masses than that of conventional EUS; however, the difference between the areas under the receiver operating characteristic curves was not statistically significant. CONCLUSIONS: CEH-EUS can complement conventional EUS in the diagnosis of pancreatic and gallbladder masses, in terms of the limitations of the latter.

The role of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic cancer / 中华消化内镜杂志

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.

Contrast-enhanced harmonic EUS in diagnosis of pancreatic occupying lesions / 中华消化内镜杂志

ObjectiveTo evaluate the accuracy of contrast-enhanced harmonic EUS (CEH-EUS) by using a second-generation contrast medium in differential diagnosis of pancreatic occupying lesions.MethodsPatients with suspected pancreatic neoplasms or chronic pancreatitis were enrolled and underwent CEH-EUS by using ultrasonic contrast medium Sonovue.Cytological and/or histological diagnoses were made by EUS-FNA and the final follow-up results.Characteristics of enhancement of the target areas,such as enhancement sequence,time features,pattern grade and venous elution degree were investigated.ResultsA total of 23 patients were enrolled,in which 13 were diagnosed with FNA as having pancreatic cancer,7 with chronic pancreatitis,2 with intraductal papillary mucinous neoplasms and 1 with microcystic serous cystadenoma.The accuracy of CEH-EUS was 95.65％,which was significantly higher than that of conventional EUS (78.2％).Enhancement of pancreatic cancer by CEH-EUS was later than or simultaneous with the nearby tissues,with heterogeneous low enhancement or fulfillment defect areas,and early subsidence without obvious peak.Enhancement of benign pancreatic diseases was simultaneous with the surrounding tissues,with homogenous fulfillment and simultaneous subsidence.ConclusionCEH-EUS is safe,convenient and accurate in diagnosis of pancreatic occupying lesions and can be used as an additional diagnostic method to EUSFNA.