Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions.
Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions.
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DOI：
10.7178/eus.03.005
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发表时间：
2012-10
影响因子：
4.5
通讯作者：
Giovannini M
中科院分区：
文献类型：
--
作者：
Figueiredo FA;da Silva PM;Monges G;Bories E;Pesenti C;Caillol F;Delpero JR;Giovannini M
虽然内镜超声引导下细针穿刺（EUS-FNA）是诊断胰腺病变的金标准，但其阴性预测值并不理想。我们的目的是评价对比增强EUS（CED-EUS）和应变比EUS弹性成像（SR-E-EUS）鉴别胰腺实性病变的能力。47例患者（27例男性，20例女性，70 ± 11岁）连续参与了这项单中心前瞻性研究。将其提交给EUS、SR-E-EUS、CED-EUS（使用Sonovue®）和EUS-FNA。最终诊断基于EUS-FNA和/或手术标本（如可用）的组织学评估以及至少6个月的随访。47例胰腺局灶性病变中，良性病变13例（28%），恶性病变34例（72%）。恶性肿瘤患者年龄较大（70 ± 11 vs. 61 ± 8，P = 0.003），病变较大（34 ± 12 mm vs. 22 ± 11 mm，P = 0.03）。恶性病变SR-E-EUS高（31 ± 32 vs. 8 ± 9，P = 0.001），低血供型多（93% vs. 33%，P < 0.001）。Logistic回归分析表明，只有低血供（OR = 2.6，95%CI：1.5-130，P = 0.02）是恶性肿瘤的独立预测因素。SR-E-EUS的ROC分析得出恶性肿瘤最佳功效区分的最佳截止值为8（AUC 0.91，95%CI：0.74-0.98）。EUS-FNA、SR-E-EUS和CED-EUS的敏感性（79%、90%、93%）和特异性（85%、75%、67%）无显著差异。通过对不确定的EUS-FNA亚组（9例患者，19%）的分析，SR-E-EUS > 8和血供减少的敏感性分别为80%和100%，特异性分别为67%和67%。CED-EUS和SR-E-EUS的临床实用性仍存在疑问。CED-EUS和SR-E-EUS的准确性与EUS-FNA相似。血供不足是恶性肿瘤的独立预测指标。EUS-FNA不确定的患者可以受益于CED-EUS，因为血管减少诊断恶性肿瘤的敏感性高。
Although endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the gold standard for diagnosing pancreatic lesions, its negative predictive value is suboptimal. Our aim was to evaluate the yield of contrast-enhanced EUS (CED-EUS) and of strain ratio EUS-elastography (SR-E-EUS) for differentiating pancreatic solid lesions. Forty-seven patients (27 men, 20 women, 70 ± 11 years) were consecutively involved in this single-center, prospective study. They were submitted to EUS, SR-E-EUS, CED-EUS with Sonovue®, and EUS-FNA. The final diagnosis was based on the histological assessment of EUS-FNA and/or surgical specimens when available, and on follow-up of at least 6 months. From the 47 focal pancreatic lesions included, 13 (28%) were benign and 34 (72%) malignant. Patients with malignancy were older (70 ± 11 vs. 61 ± 8, P = 0.003), and had larger lesions (34 ± 12 mm vs. 22 ± 11 mm, P = 0.03). Malignant lesions had higher SR-E-EUS (31 ± 32 vs. 8 ± 9, P = 0.001) and more hypovascular pattern (93% vs. 33%, P < 0.001). Logistic regression determined that only hypovascularity (OR = 2.6, 95%CI: 1.5-130, P = 0.02) was independently predictive of malignancy. ROC analysis for SR-E-EUS yielded an optimal cutoff of 8 (AUC 0.91, 95%CI: 0.74-0.98) for the best power distinction for malignancy. There was no significant difference concerning sensitivity (79%, 90%, 93%) and specificity rates (85%, 75%, 67%) of EUS-FNA, SR-E-EUS, and CED-EUS, respectively. By analysis of the inconclusive EUS-FNA subset (9 patients, 19%), SR-E-EUS > 8 and hypovascularity showed sensitivity of 80% and 100%, and specificity of 67% and 67%, respectively. The clinical utility of CED-EUS and SR-E-EUS remains questionable. The accuracies of CED-EUS and SR-E-EUS are similar to EUS-FNA. Hypovascularity was independently predictive of malignancy. Patients with inconclusive EUS-FNA could benefit from CED-EUS due to the high sensitivity of hypovascularity for diagnosing malignancy.
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影响因子：
9.3
作者：
Napoleon, B.;Alvarez-Sanchez, M. V.;Ponchon, T.
通讯作者：
Ponchon, T.
影响因子：
4.3
作者：
Hocke, Michael;Schulze, Ewald;Dietrich, Christoph F.
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Dietrich, Christoph F.
影响因子：
9.3
作者：
Giovannini, M;Hookey, LC;Delpero, JR
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Delpero, JR
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作者：
Hirche, T. O.;Ignee, A.;Dietrich, C. F.
通讯作者：
Dietrich, C. F.
影响因子：
12.6
作者：
Dietrich, Christoph F.;Ignee, Andre;Hocke, Michael
通讯作者：
Hocke, Michael