Added value of intravenous contrast-enhanced ultrasound for characterization of cystic pancreatic masses: a prospective study on 37 patients (original) (raw)
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Ultrasound Tomography in Diagnosing Cystic Pancreatic Neoplasms
Folia Medica, 2011
the clinical, radiologic, and pathologic features of cystic pancreatic lesions are well known, and yet preoperative diagnosis is often difficult to make. aim: to present the role of ultrasound study in conventional and interventional diagnostics of cystic pancreatic neoplasms. Patients and methOds: 65 patients (17 men, 48 women) with cystic pancreatic lesions were examined by ultrasound and computer tomography and investigated using a number of diagnostic interventional procedures over three years. we used siemens-Adara ultrasound system, Ge Sytec 3000i CT equipment and a set of biopsy needles and catheters. Results: We performed ultrasound studies for all 65 patients to determine the structural characteristics of the cystic lesions. Lesions varied in size from 15 to 130 mm in diameter. In 50 patients we used Us control to perform the invasive procedures for cytological and histological examination. In 9 cases the invasive procedures were repeated. In 15 cases we preferred to use CT guidance. We were able to detect 46 pseudo cysts, 9 mucinous neoplasms, 6 serous cystadenomas, 3 intraductal papillary mucinous neoplasms and 2 lymphoepithelial cysts. cOnclusiOns: ultrasound tomography is an imaging method of sufficient informative value with respect to the structural characteristics of cystic pancreatic neoplasms. Us-guided invasive manipulations of cystic pancreatic lesions are easy to perform, quick and effective diagnostic methods. In some cases punctures and biopsies under Ct control appear to be the imaging modality of choice.
European Journal of Molecular & Clinical Medicine, 2021
Background and aims:To evaluate the advantages of endoscopic ultrasound (EUS) in the assessment of detailed structures of pancreatic cystic lesions (PCLs) compared to computed tomography (CT) and magnetic resonance imaging (MRI). Methods: This prospective cohort study was conducted in Tropical medicine department, Zagazig university hospitals and in Internal medicine department at Kasr Al Aini Hospitals, Cairo University, in the period between March 2018 and March 2020. The study included 72 patients with PCLs, 29 were males and 43 were females, there ages ranged from 25 to 75 years. All cases were subjected to the following careful history taking, thorough clinical examination, laboratory investigations (CBC, LFTs, KFTs, Coagulation profile, serum amylase, serum CA 19.9), imaging (CT and/or MRI abdomen), endoscopic ultrasound examination and EUS-FNA biopsies using the 22G or 19G needle. Results:Validity of abdominal CT/MRI imaging, EUS, cytopathology and EUS with cytopathology was calculated using diagnostic performance depend on sample 2x2 contingency tables generation. Sensitivity, specificity, PPV, NPV and accuracy and their corresponding 95% CI were calculated. P-value < 0.05 was considered statistically significant, p-value < 0.001 was considered highly statistically significant, and p-value ≥ 0.05 was considered statistically insignificant. In our study, all, EUS, FNA cytopathology and EUS with FNA cytopathology showed high significant statistical differences in the detection of malignant cysts from benign cysts with pvalue of < 0.001, while abdominal CT/MRI imaging showed no significant difference. The diagnostic performance of EUS increased with the addition of FNA cytopathology which was more than of abdominal CT/MRI imaging.
Gastroenterology, 2003
BACKGROUND: The differentiation of benign from malignant intraductal papillary mucinous tumors (IPMT) is often difficult even by various examination methods. We evaluated the qualitative and quantitative diagnostic ability of contrast-enhanced transabdominal ultrasonography (CE-US), mainly in differentiating benign from malignant tumors in patients with IPMT. PATIENTS: There were 21 patients with IPMT who underwent CE-US and endoscopic ultrasonography AND METHODS: (EUS). Surgery was performed in all 21 patients. Pathological findings were 4 with carcinoma and 17 with adenoma. CE-US was performed using a contrast agent (Levovist; Tanabe, Osaka, Japan) consisting of galactose microbubbles and a small (0.1%) admixture of palmitic acid, and the following items were evaluated by the following procedure. (1) Two reviewers with experienced sonographic and endosonographic ability evaluated CE-US images before and after contrast enhancement and classified the enhancement effects into three grades. In addition, the presence or absence of enhancement effects by CE-US was compared with that of mural nodules visualized by EUS. (2) In all 21 patients, changes in intensity after contrast enhancement were quantitatively measured using an HDI Lab. HDI Lab was provided by ATL (Philips; Bothell, WA) and these software tools rapidly quantify image characteristics within multiple ROI (regions of interest) and make comparisons between several areas or images. In both the early and late phases, the postenhancement intensity, difference between pre-and postenhancement intensity, and the percentage change ((postenhancement value-preenhancement value)/preenhancement value) were compared between malignant and benign lesions, and the ability of CE-US to differentiate between benign and malignant lesions was evaluated in comparison with the ability of EUS to diagnose the degree of malignancy. RESULTS: (1) In both the early and the late phases, both reviewers observed enhancement effects in all 21 patients. And both reviewers observed mural nodules by EUS in all 21 patients. (2) In all 21 patients who underwent resection of IPMT, the intensity increased in both the early and late phases. When the patients with carcinoma were compared with those with adenoma, the postenhancement intensity was significantly higher, and the difference between pre-and postenhancement intensity and the percentage change in the early phase and the late phase was significantly more marked in the carcinoma group (p = 0.019, p = 0.002, p = 0.015, p = 0.012, and p = 0.039, respectively). CONCLUSIONS: CE-US was useful for qualitatively diagnosing tumor lesions in patients with IPMT. Moreover, quantitative changes in intensity can be a parameter for the differential diagnosis of benign and malignant tumors.
Journal of gastrointestinal and liver diseases : JGLD, 2012
AIMS. The aim of this study was to evaluate the leading causes of discrepancies between imaging studies [contrast enhanced ultrasound (CEUS) and contrast enhanced computer tomography (CECT)] diagnosis and histology in patients presenting to a tertiary referral center with previously detected pancreatic masses by standard abdominal ultrasound. METHODS. We performed a prospective longitudinal observational study on 76 patients with pancreatic masses: 57 (75%) patients with solid pancreatic tumors and 19 (25%) patients with cystic and mixed pancreatic masses. For each tumor the CEUS and CECT features were analyzed and compared with the final histological diagnosis. RESULTS. Testing the performance of CEUS and CECT in evaluating the benign or malignant etiology of pancreatic masses, we obtained a probability of 82% for CEUS and of 83% for CECT, for a randomly selected individual from the pancreatic tumor group to have an imaging result indicating suspicion for malignancy. We obtained di...
Diagnostics
Endoscopic ultrasound fine needle aspiration (EUS-FNA) cytology from an intracystic fluid is useful in the differentiation of pancreatic cysts, with low sensitivity, which increases when the solid component is targeted. The clinical utility of contrast-enhanced guided EUS-FNA (CH-EUS-FNA) in the solid component is not known. We aimed to assess the diagnostic value of CH-EUS-FNA in enhanced mural nodules and discrimination between different cysts using contrast-enhanced endoscopic ultrasound (CH-EUS). The prospective study recruited patients with pancreatic cysts with an unclear diagnosis. The CH-EUS was followed by CH-EUS-FNA. The final diagnosis was based on surgery or the correlation between clinical history, cross-sectional imaging, echoendoscopic morphology, cystic fluid analysis, and follow-up. Fifty-eight patients with pancreatic cysts were evaluated. The mucinous cysts had wall arterial enhancement more often than non- mucinous cysts (p < 0.0001), with 90.2% sensitivity an...
Endoscopic ultrasound
The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst am...
Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions
Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology, 2019
BACKGROUND AND STUDY AIMS pancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. PATIENTS AND METHODS This prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months. RESULTS The highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 wa...
World journal of gastroenterology : WJG, 2007
To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. 46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/pre-malignant (mucinous cystic neoplasm). Receiver-operator characteristics (ROC) curve analysis was performed. The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/pre-malignant lesions. Sensitivity, specificity and p...
Journal of gastrointestinal and liver diseases : JGLD, 2009
Contrast-enhanced ultrasound is a relatively new technique, currently used for liver tumors diagnosis. Newer contrast agents are composed of stabilized micro-bubbles capable of traversing the capillary circulation. Lately, the method has also been used in the assessment of pancreatic disorders. Pulse inversion harmonic imaging allows the assessment of the hypervascularised masses as neuroendocrine tumors, of the hypoperfused masses as adenocarcinomas and of the necrotic areas in acute pancreatitis. Also, this imaging method allows a better assessment of the pancreatic tumor resectability and the identification of septa inside the cystic lesion. Contrast-enhanced ultrasound might represent a valuable additional imaging method to contrast CT for selected cases.