Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy

Table 3 Results of contrast-enhanced harmonics-endoscopic ultrasound assessment for solid pancreatic masses in various studies

Ref.	Type of study	Contrast agent	No. of patients	MI	Hypoenhancement as a sign of adenocarcinoma	EUS diagnostic rate	EUS-FNA diagnostic rate
Napoleon et al[18] 2010	Endoscopy	Sonovue	35	0.4	Sn = 89%		Sn = 79%
			PC-18		Sp = 88%		Sp = 100%
			NET-9		PPV = 89%		PPV = 100%
			CP-7		NPV = 88%		NPV = 54%
					Acc = 88.5%		Acc = 83%
Fusaroli et al[12] 2010	Prospective	Sonovue	90	0.36 radial	Sn = 96%	Sn = 86%
			PC-51, NET-13, CP-13	0.28 linear	Sp = 64%	Sp = 18%
					Ac = 82%	Ac = 57%
Ang et al[19] 2011		Definity	29 (PC-16, CP-4, Other-9)	0.3	Better detection of vascular invasion and tumor margins		-
Matsubara et al[20] 2011	Retrospective	Sonazoid	91	0.2	Sn = 87.5%	-	-
					Sp = 77.8%
Hocke et al[13] 2012	Prospective	Sonovue	58	-	Sn = 84%	Sn = 73%	-
					Sp = 76%	Sp = 61%
Kitano et al[15] 2012	Prospective	Sonazoid	277 (PC-204, NET-19, CrP-46, Other-8)	0.3	Sn = 95%	-	Sn = 92%1
					Sp = 89%		Sp = 100%
Lee et al[16] 2013	Prospective	Sonovue	37 (PC-28, NET-5, CP-2)	-	Sn = 93%	-	-
					Sp = 86%
					PPV = 93%
					NPV = 75%
					Acc = 92%
Gincul et al[14] 2014	Prospective	Sonovue	100	0.4	Sn = 96%		Sn = 95%
			(PC-69,		Sp = 94%		Sp = 93%
			NET-10, CP-13,		PPV = 94%		PPV = 100%
			Other-8)		NPV = 97%		NPV = 100%
					Acc = 91%		Acc = 86%
Park et al[17] 2014	Retrospective	Sonovue	90	-	Sn = 91.9%	-	Sn = 90%
					Sp = 67.8%		Sp = 100%
Dietrich et al[21] 2016	Retrospective	Sonovue	394		Sn = 92%	-	-
			PC-146
			NET-156

¹91 patients with resected lesions. MI: Mechanical index; PC: Pancreatic cancer; Cp: Chronic pancreatitis; NET: Neuroendocrine tumors; PPV: Positive predictive value; NPV: Negative predictive value; Sn: Sensitivity; Sp: Specificity; EUS-FNA: Endoscopic ultrasound-fine needle aspiration.