Impact of endoscopic ultrasound elastography in pancreatic lesion evaluation

Table 1 Summary of the studies utilizing endoscopic ultrasound elastography for evaluating pancreatic lesions

Ref.	Population of the study	Key findings
Giovannini et al[13], 2006	24 patients with pancreatic masses.	Sensitivity 100% and specificity 67% in diagnosing malignant lesions.
		Sensitivity 100% and specificity 50% in diagnosing malignant invasion of lymph nodes.
Uchida et al[6], 2009	Phase 1: pancreatic cancer (5 subjects), endocrine tumor (2 subjects), chronic pancreatitis (5 subjects), intraductal papillary mucinous neoplasm.	Diagnostic performance of real-time tissue elastography mode for diagnosing malignancy: Operator vs another reviewer
		Sensitivity: 64.3% vs 60.7%.
		Specificity: 88% vs 88%.
		Positive predictive value: 85.7% vs 85%.
	Phase 2: 53 consecutive subjects with pancreatic lesions visible on B-mode images.	Negative predictive value: 68.8% vs 66.7%.
Iglesias-Garcia et al[14], 2009	130 consecutive patients with solid pancreatic masses vs 20 subjects with normal pancreases.	Diagnostic performance of EUS elastography in diagnosing malignancy
		Sensitivity: 100%.
		Specificity: 85.5%.
		Positive predictive value: 90.7%.
		Negative predictive value: 100%.
		Overall accuracy: 94%.
Hirche et al[4], 2008	70 patients with unclassified solid pancreatic lesions vs 10 subjects with healthy pancreas.	Diagnostic performance of EUS elastography in predicting the nature of pancreatic lesions
		Sensitivity: 41%.
		Specificity: 53%.
		Accuracy: 45%.
Janssen et al[15], 2007	20 patients with chronic pancreatitis vs 33 patients with focal pancreatic lesions vs 20 subjects with normal pancreas.	Diagnostic performance of EUS elastography in diagnosing chronic pancreatitis
		Sensitivity: 65.9%.
		Specificity: 56.9%.
		Accuracy: 60.2%.
		Diagnostic performance of EUS elastography in diagnosing focal pancreatic lesions
		Sensitivity: 93.8%.
		Specificity: 65.4%.
		Accuracy: 73.5%.
		Diagnostic performance of EUS elastography in differentiating pancreatic adenocarcinoma and inflammatory pancreatic masses
Li et al[16], 2013	Meta-analysis of 10 studies with 781 patients.	Diagnostic performance of EUS elastography in differentiating pancreatic adenocarcinoma and inflammatory pancreatic masses
		AUC: 0.8227.
		In studies with color pattern as the diagnostic standard
		Sensitivity: 99%.
		Specificity: 76%.
		Positive likelihood ratio: 3.36.
		Negative likelihood ratio: 0.03.
		Diagnostic odds ratio: 129.96.
		In studies with hue histogram as the diagnostic standard
		Sensitivity: 92%.
		Specificity: 68%.
		Positive likelihood ratio: 2.84.
		Negative likelihood ratio: 0.12.
		Diagnostic odds ratio: 24.69.
Xu et al[17], 2013	Meta-analysis of 9 studies.	Diagnostic performance of EUS elastography in differentiating benign and malignant pancreatic masses
		In studies with qualitative color pattern as the diagnostic standard
		Sensitivity: 99%.
		Specificity: 74%.
		AUROC: 0.9624.
		In studies with quantitative hue histogram value as the diagnostic standard
		Sensitivity: 85%-93%.
		Specificity: 64%-76%.
Mei et al[18], 2013	Meta-analysis of 13 studies with 1044 patients.	Diagnostic performance of EUS elastography in differentiating benign and malignant solid pancreatic masses
		Sensitivity: 95%.
		Specificity: 67%.
		Diagnostic odds ratio: 42.28.
Altonbary et al[19], 2019	97 patients with malignant lesions vs 19 patients with benign lesions	Diagnostic performance of combined elasticity score and strain ratio in differentiating benign and malignant pancreatic lesions (cut-off point: 7.75)
		Sensitivity: 99%.
		Specificity: 94.6%.
		Positive predictive value: 98%.
		Negative predictive value: 98.5%.
		Accuracy: 97%.
Ignee et al[20], 2018	218 patients with solid pancreatic lesions sized ≤ 15 mm and a definite diagnosis.	Diagnostic performance of EUS elastography with high stiffness of the lesion in diagnosing malignancy
		Sensitivity: 84%.
		Specificity: 67%.
		Positive predictive value: 56%.
		Negative predictive value: 89%.
		Diagnostic performance of EUS elastography in diagnosing pancreatic ductal adenocarcinoma
		Sensitivity: 96%.
		Specificity: 64%.
		Positive predictive value: 45%.
		Negative predictive value: 98%.

EUS: Endoscopic ultrasound.