Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 19-27
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.19
Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine
Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Anja Peters, Torsten Kucharzik, Christian Maaser
Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Torsten Kucharzik, Christian Maaser, Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg 21339, Germany
Anja Peters, Department of Pathology, University Teaching Hospital Lueneburg, Lueneburg 21339, Germany
Author contributions: Kannengiesser K, Kucharzik T, Petersen F and Maaser C designed the research; Kannengiesser K, Mahlke R, Kucharzik T and Maaser C performed EUS investigatons; Peters A performed histological analyses; Kannengiesser K, Kucharzik T and Maaser C analysed the data and wrote the manuscript; All authors revised the manuscript.
Institutional review board statement: The local ethics committee state that for this retrospective anonymous data analysis no formal approval was necessary.
Informed consent statement: All patients signed informed consent for the investigations carried out. As an anonymous retrospective analysis there was no formal informed consent for the data analysis later on.
Conflict-of-interest statement: No conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Corresponding author: Klaus Kannengiesser, MD, Academic Fellow, Doctor, Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Boegelstrasse 1, Lueneburg 21339, Germany.
Telephone: +49-4131-772241 Fax: +49-4131-772245
Received: October 30, 2018
Peer-review started: October 31, 2018
First decision: November 28, 2018
Revised: December 4, 2018
Accepted: December 21, 2018
Article in press: December 21, 2018
Published online: January 6, 2019

Contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.


To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.


Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively. Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation, quantitative analysis was performed later on. Samples from fine needle aspiration (EUS-FNA) or surgical specimen served as gold standard.


CEH-EUS showed 39 hypoenhanced lesions, 3 non-enhanced and 13 hyperenhanced lesions. Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%, while other parameters such as arrival time, time to peak or area under the curve did not show additional value. 34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma; of the hyperenhanced lesions 4 were inflammatory, 3 neuroendocrine carcinomas, 1 lymphoma, 1 insulinoma and 4 metastases (2 of renal cell carcinoma, 2 of lung cancer). Non-enhanced lesions showed up as necroses. Sensitivity for the detection of pancreatic adenocarcinoma was 100%, specificity 87.2% for hypoenhancement alone; in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma (sensitivity and specificity 100%, PPV and NPV for adenocarcinoma 100%).


This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma. Additional quantitative analysis of perfusion parameters does not add diagnostic yield. In case of the various hyperenhanced pancreatic lesions in our data set, histologic sampling is essential for further treatment.

Keywords: Endoscopic ultrasound, Contrast enhanced endoscopic ultrasound, Pancreatic adenocarcinoma, Neuroendocrine carcinoma, Pancreatic metastases, Lymphoma

Core tip: In the diagnostic of focal pancreatic lesions, several studies showed a good value of Contrast enhanced endoscopic ultrasound (CEH-EUS) in detecting pancreatic adenocarcinoma, while less is known about other focal pancreatic pathologies. In our retrospective cohort, we can confirm the good value of CEH-EUS for the detection of pancreatic adenocarcinoma. We additionally show the high value of instant qualitative evaluation of CEH-EUS images in everyday routine as well as the limitations of quantitative analyses, making precise quantification dispensable. Moreover, we describe perfusion characteristics of several other solid pancreatic masses of different origin.