Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value

Figure 1 Distribution of strain ratio values among malignant (red) and nonmalignant (blue) pancreatic masses and their associated lymph nodes. ^aMann-Whitney U test. SR: Strain ratio.

Figure 2 Areas under the receiver operating characteristic curve. A: Areas under the receiver operating characteristic curve (AUROC) of the strain ratio in the detection of malignancy in pancreatic masses [AUROC = 0.685 (0.586–0.783)], B: AUROC of the strain ratio in the detection of malignancy in only solid pancreatic masses [AUROC = 0.713 (0.602–0.825)]; C: AUROC of the strain ratio in the detection of malignancy in associated lymph nodes [AUROC = 0.417 (0.076–0.757)]. There was no significant difference between AUROC–A and AUROC–B (P = 0.7073). AUROC: Areas under the receiver operating characteristic curve.

Figure 3 Quantitative and qualitative endoscopic ultrasound elastography assessment. A: Case No. 84: A 26-year-old women with a pancreatic mass. A plain B-mode image (left) and a color-code strain image (right) are shown, strain ratio (SR) = 2.66, Giovannini elastic score of 2 (green). Biopsy confirmed chronic pancreatitis; B: Case No. 73: A 46-year-old man with a pancreatic mass. A plain B-mode image (left) and a color-coded strain image (right) are shown, SR = 23.8, Giovannini elastic score of 4 (dark blue). Biopsy confirmed pancreatic adenocarcinoma.

Figure 4 Proposed algorithm for the workup of pancreatic masses. SR: Strain ratio; EUS: Endoscopic ultrasound; CT: Computed tomography; MR: Magnetic resonance.