Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos)

TY - JOUR

T1 - Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos)

AU - Săftoiu, Adrian

AU - Vilmann, Peter

AU - Dietrich, Christoph F

AU - Iglesias-Garcia, Julio

AU - Hocke, Michael

AU - Seicean, Andrada

AU - Ignee, Andre

AU - Hassan, Hazem

AU - Streba, Costin Teodor

AU - Ioncică, Ana Maria

AU - Gheonea, Dan Ionuţ

AU - Ciurea, Tudorel

N1 - Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - BACKGROUND: The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation.OBJECTIVE: To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP).SETTING: Prospective, multicenter, observational trial-endoscopy units from Romania, Denmark, Germany, and Spain.PATIENTS: A total of 167 consecutive patients with PC or CP.INTERVENTIONS: Contrast-enhanced harmonic EUS (CEH-EUS) and EUS-guided FNA (EUS-FNA), TIC analysis, and ANN processing.MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN.RESULTS: After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%.LIMITATIONS: Only PC and CP lesions were included.CONCLUSION: Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used in an automated computer-aided diagnostic system with good diagnostic results. (CLINICAL TRIAL REGISTRATION NUMBER: NCT01315548.).

AB - BACKGROUND: The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation.OBJECTIVE: To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP).SETTING: Prospective, multicenter, observational trial-endoscopy units from Romania, Denmark, Germany, and Spain.PATIENTS: A total of 167 consecutive patients with PC or CP.INTERVENTIONS: Contrast-enhanced harmonic EUS (CEH-EUS) and EUS-guided FNA (EUS-FNA), TIC analysis, and ANN processing.MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN.RESULTS: After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%.LIMITATIONS: Only PC and CP lesions were included.CONCLUSION: Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used in an automated computer-aided diagnostic system with good diagnostic results. (CLINICAL TRIAL REGISTRATION NUMBER: NCT01315548.).

KW - Adenocarcinoma

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Contrast Media

KW - Diagnosis, Computer-Assisted

KW - Diagnosis, Differential

KW - Endoscopic Ultrasound-Guided Fine Needle Aspiration

KW - Endosonography

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Neural Networks (Computer)

KW - Pancreatic Neoplasms

KW - Pancreatitis, Chronic

KW - Prospective Studies

KW - Sensitivity and Specificity

U2 - 10.1016/j.gie.2014.11.040

DO - 10.1016/j.gie.2014.11.040

M3 - Journal article

C2 - 25792386

SN - 0016-5107

VL - 82

SP - 59

EP - 69

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 1

ER -