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

Yıl 2020, Cilt: 3 Sayı: 2, 158 - 165, 19.03.2020

Özlem Gül Utku , Bilal Ergül , Eylem Karatay , Cumali Efe , Nesrin Turhan , Dilek Oğuz

https://doi.org/10.32322/jhsm.694535

Öz

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

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Mondal U, Henkes N, Patel S, Rosenkranz L. Endoscopic Ultrasound Elastography: Current Clinical Use in Pancreas. Pancreas 2016; 45: 929-33.
• 2. Pei Q, Zou X, Zhang X, Chen M, Guo Y, Luo H. Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: a meta-analysis. Pancreatology 2012; 12: 402-8.
• 3. Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics 2017; 7: 1303-29.
• 4. Cui XW, Chang JM, Kan QC, Chiorean L, Ignee A, Dietrich CF. Endoscopic ultrasound elastography: Current status and future perspectives. World J Gastroenterol 2015; 21: 13212-24.
• 5. Okasha HH, Mahdy RE, Elkholy S, et al. Endoscopic ultrasound (EUS) elastography and strain ratio, could it help in differentiating malignant from benign pancreatic lesions? Medicine (Baltimore). 2018; 97: e11689.
• 6. Dawwas MF, Taha H, Leeds JS, Nayar MK, Oppong KW. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: a prospective, single-center study. Gastrointest Endosc 2012; 76: 953-61.
• 7. Kim SY, Cho JH, Kim YJ, et al. Diagnostic efficacy of quantitative endoscopic ultrasound elastography for differentiating pancreatic disease. J Gastroenterol Hepatol 2017; 32: 1115-22.
• 8. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009; 69: 1251-61.
• 9. Giovannini M, Hookey LC, Bories E, Pesenti C, Monges G, Delpero JR. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy 2006; 38: 344-8.
• 10. Ruan Z, Jiao J, Min D, et al. Multi-modality imaging features distinguish pancreatic carcinoma from mass-forming chronic pancreatitis of the pancreatic head. Oncol Lett 2018; 15: 9735-44.
• 11. Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB. Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc 2005; 61: 854-61.
• 12. Horwhat JD, Paulson EK, McGrath K, et al. A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions. Gastrointest Endosc 2006; 63: 966-75.
• 13. Hocke M, Schulze E, Gottschalk P, Topalidis T, Dietrich CF. Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer. World J Gastroenterol 2006; 12: 246-50.
• 14. Chen G, Liu S, Zhao Y, Dai M, Zhang T. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a meta-analysis. Pancreatology 2013; 13: 298-304.
• 15. O'Toole D, Palazzo L, Arotcarena R, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc 2001; 53: 470-4.
• 16. Ying L, Lin X, Xie ZL, Hu YP, Tang KF, Shi KQ. Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: a meta-analysis. J Gastroenterol Hepatol 2013; 28: 1434-43.
• 17. Zhang B, Zhu F, Li P, Yu S, Zhao Y, Li M. Endoscopic ultrasound elastography in the diagnosis of pancreatic masses: A meta-analysis. Pancreatology 2018; 18: 833-40.
• 18. Li X, Xu W, Shi J, Lin Y, Zeng X. Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: a meta-analysis. World J Gastroenterol 2013; 19: 6284-91.