New horizons in the endoscopic ultrasonography-based diagnosis of pancreatic cystic lesions

Table 1 Contrast harmonic enhanced endoscopic ultrasound in pancreatic cystic lesions

Authors	Study	n	Main outcomes	Complications
Yamashita et al[39], 2013	P	17	Differential diagnosis between mural nodules and mucus clots: CH-EUS: Sen 100%, Spe 80%, PPV 92%, NPV 100%, A 94% CT and Doppler-EUS: Sen 41% and 0% respectively	0
Hocke et al[36], 2014	R	125	Differential diagnosis between non-neoplastic cysts and PCNs. Hyperenhancement: 100% PCNs Hypoenhancement: 94% non-neoplastic cysts (PCs and dysontogenic cysts) CH-EUS superior to EUS in differential diagnosis between PCNs and non-neoplastic cysts (aP < 0.001)	0
Harima et al[41], 2015	R	30	Performance for diagnosing mural nodules CT: Sen 71%, Spe 100%, PPV 100%, NPV 90%, A 92% EUS: Sen 72%, Spe 61%, PPV 50%, NPV 100%, A 72% CH-EUS: Sen 100%, Spe 97%, PPV 93%, NPV 100%, A 98%	0
Fujita et al[40], 2016	R	50	Sensitivity for diagnosing mural nodules: CT: 86% vs MRI 71% vs EUS 100% EUS was not able to distinguish mural nodules from mucus clots CH-EUS correctly differentiated mural nodules from mucus clots in all cases	0
Fusaroli et al[37], 2016	R	76	Differential diagnosis between non-neoplastic cysts and PCNs and between benign and malignant cysts. Hyperenhancement: 86% SCAs and 89% mucinous cysts (P = ns) Hypoenhancement: 90% PCs (bP < 0.000004 vs SCAs and cP < 0.000005 vs mucinous cysts) Hyperenhanced solid components : 100% malignant cysts Non- hype-enhanced solid components: 100% benign cysts	0
Kamata et al[38], 2016	R	70	Mural nodule as a sign of mucinous cyst EUS vs CH-EUS: Sen 85% vs 79%, Spe 46% vs 96%, A 73% vs 84% (P = 0.057) Mural nodule as a sign of malignancy EUS vs CH-EUS: Sen 97% vs 97%, Spe 40% vs 75%, A 64% vs 84% (dP = 0.0001)	0
Yamamoto et al[42], 2016	R	30	Quantitative CH-EUS in IPMNs Echo intensity change and echo intensity reduction rate, and nodule/parenchyma contrast ratio significantly higher in HGD/invasive carcinoma (eP < 0.05) Microvessel density in mural nodule Significantly higher in HGD/invasive carcinoma (fP < 0.002) Significant correlation between echo intensity change and microvessel density (gP < 0.001)	0

P: Prospective; R: Retrospective; CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasonography; CH-EUS: Contrast harmonic endoscopic ultrasonography; Sen: Sensitivity; Spe: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; A: Accuracy; PCNs: Pancreatic cystic neoplasms; IPMN: Intraductal papillary mucinous neoplasm; HGD: High grade dysplasia.