Noninvasive assesment in differentiating benign and malign pancreatic lesions with endosonographic elastography score and strain ratio

Abstract

Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single centre during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/42 (63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) had neuroendocrine tumors. Among 28 patients with benign pancreatic lessions, 23 (82.1%) had CP while five (17.9%) had autoimmune pancreatitis. Median SR values were significantly higher in patients with SPL than those with CP (44.0 (10.0-110.0) vs 7.0 (2.6-14.6), p<0.001). Elasticity scores were also significantly different between patients with SLP and CP (p<0.001). Elasticity scores were significantly different between adenocarcinomas and CP (p<0.001). A 14 cut-off value of SR had 97% sensitive and 100% specificity for SPL and receiver-operating characteristic curves showed an area under the curve of 0.99.6. Likelihood Ratio test revealed that SR appears as the best parameter in discrimination of lesion type either as benign or malignant (X2 = 54.031, p<0.001). Conclusion: Our study suggested that EUS-elastography and SR scores are highly effective in differentiating malign-benign pancreatitis lesions

Keywords

• Chronic pancreatitis,endoscopic ultrasound,elastography,solid pancreatic lesions,strain ratio

Benign ve malign pankreas lezyonlarının ayırıcı tanısında endossonografik elastografi skoru ve sertlik oranları ile noninvaziv değerlendirme

Abstract

Amaç: Benign pankreas lezyonlarının malign lezyonlardan ayırt edilmesi için endoskopik ultrason elastografisi (EUS-EG) ve gerinim oranının (SR) tanısal yeteneğini değerlendirmeyi amaçladık. Gereç ve Yöntem: Ocak 2016-Haziran 2019 döneminde tek merkezde EUS-EG uygulanan hastaların iyi toplanmış verilerini retrospektif olarak değerlendirdik. Pankreas bozukluğu olan hastalar da çalışma için değerlendirildi. Katı pankreas lezyonlarının (SPL) kesin tanısı histopatolojik inceleme ile konuldu. Kontrol grubu, Rosemont kriterlerine göre teşhis edilen kronik pankreatitli (CP) hastalardan oluşmaktaydı. Elastografi kalitatif (elastografi skorları) ve kantitatif SR yöntemi ile değerlendirildi. Bulgular: Ortalama yaş 58,8±15,3 (19-80) olan toplam 66 hasta (42 (%63,6) kadın / 42 (%63,6) erkek) çalışmaya dahil edildi. Otuz sekiz hastada SLP; 28 hastada CP vardı. SPL grubunda 32'sinde (%84,2) adenokarsinom, 6'sında (%15,8) nöroendokrin tümör vardı. Benign pankreatik dersleri olan 28 hastanın 23'ünde (%82,1) CP, beşinde (%17,9) otoimmün pankreatit vardı. SPL'li hastalarda medyan SR değerleri CP'li hastalardan anlamlı olarak daha yüksekti (44,0 (10,0-110.0) ve 7,0 (2,6-14,6), p<0.001). Esneklik skorları da SLP ve CP'li hastalar arasında anlamlı olarak farklıydı (p<0.001). Elastikiyet skorları adenokarsinom ve CP arasında anlamlı olarak farklıydı (p<0.001). 14 kesme değeri SR, SPL ve alıcı işletim karakteristik eğrileri için %97 duyarlı ve %100 özgüllüğe sahipti ve 0.99.6 eğrisinin altında bir alan gösterdi. Olabilirlik Oran testi, SR'nin lezyon tipinin benign veya malign olarak ayırt edilmesinde en iyi parametre olarak göründüğünü göstermiştir (X2=54,031, p<0.001). Sonuç: Çalışmamız, EUS-elastografi ve SR skorlarının malign benign pankreatit lezyonlarını ayırmada oldukça etkili olduğunu önermektedir.

Keywords

• Kronik pankreatit,endoskopik ultrason,elastografi,solid pankreas lezyonları,gerinim oranı

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