Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 524-535
Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.524
Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value
Miguel Puga-Tejada, Raquel Del Valle, Roberto Oleas, Maria Egas-Izquierdo, Martha Arevalo-Mora, Jorge Baquerizo-Burgos, Jesenia Ospina, Miguel Soria-Alcivar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda
Miguel Puga-Tejada, Raquel Del Valle, Roberto Oleas, Maria Egas-Izquierdo, Martha Arevalo-Mora, Jorge Baquerizo-Burgos, Jesenia Ospina, Miguel Soria-Alcivar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda, Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil 090505, Guayas, Ecuador
Miguel Soria-Alcivar, Universidad de Guayaquil, Guayaquil 090505, Guayas, Ecuador
Author contributions: Puga-Tejada M and Oleas R performed design of the work, acquisition, analysis, and interpretation of data, drafting and critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Del Valle R, Egas-Izquierdo M, Ospina J and Soria-Alcivar M contributed to the acquisition of data for the work, critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Egas-Izquierdo M performed the final database consolidation and encryption; Arevalo-Mora M and Baquerizo-Burgos J contributed to the acquisition and analysis of data, drafting the manuscript, and final approval of the version to be published; Pitanga-Lukashok H contributed to the conception and design of the work, critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Robles-Medranda C contributed to the conception and design of the work, drafting and critical revision of the manuscript for important intellectual content, and final approval of the version to be published.
Institutional review board statement: The Institutional Review Board approved the use and management of the corresponding data, No. 11-01-02103.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Microtech, G-Tech Medical Supply, CREO Medical, EndoSound, and Mdconsgroup. The other authors declare no conflicts of interest.
Data sharing statement: The Institutional Review Board approved the use and management of the corresponding data, and the study was conducted in accordance with the Declaration of Helsinki.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos Robles-Medranda, MD, Chief Physician, Director, Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel R Castillo y, Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Guayas, Ecuador. carlosoakm@yahoo.es
Received: May 24, 2022
Peer-review started: May 24, 2022
First decision: June 27, 2022
Revised: July 15, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 16, 2022
Abstract
BACKGROUND

Endoscopic ultrasound (EUS) can detect small lesions throughout the digestive tract; however, it remains challenging to accurately identify malignancies with this approach. EUS elastography measures tissue hardness, by which malignant and nonmalignant pancreatic masses (PMs) and lymph nodes (LNs) can be differentiated. However, there is currently little information regarding the strain ratio (SR) cutoff in Hispanic populations.

AIM

To determine the diagnostic accuracy of EUS elastography for PMs and LNs with an SR cutoff value in Hispanics.

METHODS

A retrospective study of patients who underwent EUS elastography for PMs between December 2013 and December 2014. A qualitative (analysis of color maps) and quantitative (SR) analysis of PMs and their associated LNs was performed. The accuracy of EUS elastography in identifying malignant PMs and LNs and cutoff value for SR were analyzed. A PM and/or its associated LNs were considered malignant based on histopathological findings from fine-needle aspiration biopsy samples.

RESULTS

A sample of 121 patients was included, 45.4% of whom were female. 69 (57.0%) PMs were histologically malignant, with a median SR of 50.4 vs 33.0 for malignant vs nonmalignant masses (P < 0.001). EUS evaluation identified associated LNs in 43/121 patients (35.5%), in whom 22/43 (51.2%) patients had histologically confirmed malignant diagnosis, with a median SR of 30 vs 40 for malignant vs nonmalignant LNs (P = 0.7182). In detecting malignancy in PMs, an SR cutoff value of > 21.5 yielded a sensitivity of 94.2%, while a cutoff value of > 121 yielded a specificity of 96.2.2%. There were significant differences in the Giovannini scores, a previously established elastic score system, between the patients grouped by their final histology results (P < 0.001). For LNs, SR cutoff values of > 14.0 and > 155 yielded a sensitivity of 90.9% and a specificity of 95.2%, respectively, in detecting malignancy.

CONCLUSION

EUS elastography is a helpful technique for the diagnosis of solid PMs and their associated LNs. The proposed SR cutoff values have a high sensitivity and specificity for the detection of malignancy.

Keywords: Ultrasound, Elastography, Pancreas, Lymph nodes, Neoplasm

Core Tip: This single-center retrospective study aimed to determine the diagnostic accuracy of endoscopic ultrasound (EUS) elastography in the diagnosis of pancreatic masses (PMs) and associated lymph nodes (LNs) with a defined strain ratio (SR) cutoff value in a Hispanic population. In determining if PMs were malignant, an SR cutoff value > 21.5 had a sensitivity of 94.2%, while a cutoff value > 121 had a specificity of 96.2.2%. For diagnosing LNs, an SR cutoff value > 14.0 had a sensitivity of 90.9%, while a cutoff value > 155 had a specificity of 95.2% for malignancy. The proposed SR cutoff values have high sensitivity and specificity for malignancy detection during EUS elastography.