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

Table 5 Contrast-enhanced endoscopic ultrasound for use in characterizing mural nodules in cystic pancreatic lesions

Ref.	Type of study	MI	No. of patients	Type of cystic lesions	Contrast substance	Detection of mural nodules accuracy	Diagnosis of malignancy	Cut-off height for malignancy diagnosis(mm)
Yamashita et al[40] 2013	Retrospective	0.36	17	IPMN	Sonazoid	EUS-0
						CT-71%
						CH-EUS-94%
Hocke et al[37] 2014	Retrospective	0.02-0.18	125	1 MCN	Sonovue	Not defined	Not defined	-
				6 MD-IPMN
				16 BD-IPMN
				103 others
Harima et al[41] 2015	Retrospective	-	50	IPMN BD	Sonazoid	CT-92%		8.8 (AUROC = 0.93)
						EUS-72%
						CH-EUS-98%
Kamata et al[42] 2016	Retrospective	0.30	70	6 MCN 42 BD-IPMNs	Sonazoid	EUS-73%	EUS-64	EUS-8 mm (AUROC = 0.84)
				4 SCN		CH-EUS-84%	CH-EUS-84	CH-EUS-4 mm (AUROC = 0.93)
				18 other
Yamamoto et al[43] 2016	Retrospective	0.20	30	6/18/2006	Sonazoid		Echo intensity change-0.8	No effect on malignancy rate
				MD/BD/Mixt IPMN			Echo intensity reduction
							rate-0.9
							Nodule/pancreatic parenchyma contrast ratio-0.89

IPMNs: Intraductal papillary mucinous neoplasms; CH-EUS: Contrast-enhanced harmonics-endoscopic ultrasound; MCN: Mucinous cystic neoplasm.