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
Research background

While some studies have shown that quantitative analysis of contrast enhanced endoscopic ultrasound (CEH-EUS) helps to identify pancreatic adenocarcinoma, there are less data from everyday routine. For non-adenocarcinoma lesions, less information of contrast agent characteristics has been published so far.

Research motivation

As in pancreatic malignancies surgery is the only potential cure, quick and efficient diagnostics are needed to guide further therapy and avoid unnecessary delay. As biopsy sampling from fine needle aspiration (EUS-FNA) requires diagnostics in an inpatient setting, alternative methods with good diagnostic accuracy would make outpatient diagnostics possible, which would be both time saving and less expensive.

Research objectives

The main research objective was to show the value of CEH-EUS in the daily routine diagnostic of various pancreatic lesions. Besides the hypoenhancement of pancreatic adenocarcinoma, which was quantitatively shown before, various other pancreatic lesions warrent future research.

Research methods

CEH-EUS data of 55 patients with solid pancreatic lesions were analysed regarding contrast agent characteristics. Statistical analysis of time to peak, peak intensity, area under the time intensity curve, arrival time were compared to qualitative evaluation during the investigation, while histological specimen or FNA results served as gold standard.

Research results

All pancreatic adenocarcinoma showed up hypoenhanced, while several other lesions including metases of other origin, lymphoma and inflammatory lesions showed up hyperenhanced. Quantitative analysis oft he EUS data did not add any value to the qualitative evaluation. Moreover, calculation of the quantitative parameters was in some cases difficult, among others due to low signal intensity in hypoenhanced lesions or due to moving artifacts.

Research conclusions

Qualitative evaluation of contrast agent characteristics is sufficient to identify pancreatic adenocarcinoma in healthy pancreatic tissue and could make EUS-FNA in patients with resectable disease dispensable. Hyperenhanced pancreatic lesions can be of various origin, which makes histological sampling essential.

Research perspectives

Especially for hyperenhanced pancreatic lesions, prospective studies are needed to broaden the experience with this intersting technique. Possibly, algorythms with different techniques such as CEH-EUS and EUS-elastography could further help to classify pancreatic masses in difficult situations such as chronic pancreatitis patients.