Contrast enhanced endosonography in diagnosis of pancreatic cancer

Czech version

Authors: B. Bunganič ¹; T. Dvořáková ¹; M. Laclav ¹; K. Kmochová ¹; E. Traboulsi ²; O. Májek ³; Š. Suchánek ¹; M. Zavoral ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN – VFN Praha ¹; Oddělení patologie, ÚVN – VFN Praha ²; Institut biostatistiky a analýz, LF MU, Brno ³
Published in: Gastroent Hepatol 2014; 68(5): 430-435
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2014430

Overview

The main objective of this work is to compare the sensitivity and specificity of conventional endosonography (EUS) and contrast enhanced harmonic endosonography (CEH EUS) for the diagnosis of pancreatic cancer. The secondary objective of the project is to determine to what extent the evaluation of CEH EUS is affected by the subjectivity of the endosonographer.

Methods:
A prospective single-center study in patients with pancreatic lesions. The patients were examined by conventional EUS followed by CEH EUS; and an endosonographic-guided fine needle biopsy was performed eventually. The obtained results were compared with the final diagnosis which was based on cytology and further clinical findings in non-operated patients or resection histology in operated subjects. The evaluation was performed for solid tumors, while cystic tumors were excluded. Retrospectively, a second reading of EUS findings was performed by another endosonographer.

Results:
We examined 54 patients, the final evaluation included 46 patients with solid tumors, and eight patients were excluded. The sensitivity, specificity, negative predictive value and positive predictive value of conventional EUS for the diagnosis of pancreatic cancer were 82.9%, 45.5%, 45.5% and 82.9%, respectively. For the CEH EUS, the same characteristics achieved 97.1%, 63.6%, 87.5% and 89.5%, respectively. The difference in sensitivity was statistically significant (p = 0.06). The interobserver agreement in the evaluation of EUS was very good (κ = 0.64), in the evaluation for the CEH EUS was satisfactory (κ = 0.45).

Conclusion:
CEH EUS is a noninvasive method that allows us to identify pancreatic cancer more accurately than conventional EUS. The subjectivity of CEH EUS evaluation is worse than that of EUS, but is still acceptable.

Key words:
contrast enhanced endosonography – fine needle aspiration biopsy – pancreatic cancer

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
7. 9. 2014

Accepted:
14. 10. 2014

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