Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study.
OBJECTIVE
To evaluate the ability of endoscopic ultrasound (EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.


METHODS
A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass (n = 121) or lymph node (n = 101). The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration (EUS-FNA) and/or by surgical pathology. An interobserver study was performed.


RESULTS
The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.


CONCLUSIONS
EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.
Giovannini
Marc
M
Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France. giovanninim@wanadoo.fr
Thomas
Botelberge
B
Erwan
Bories
B
Christian
Pesenti
P
Fabrice
Caillol
C
Benjamin
Esterni
E
Geneviève
Monges
M
Paolo
Arcidiacono
A
Pierre
Deprez
D
Robert
Yeung
Y
Walter
Schimdt
S
Hanz
Schrader
S
Carl
Szymanski
S
Christoph
Dietrich
D
Pierre
Eisendrath
E
Jean-Luc
Van Laethem
VL
Jacques
Devière
D
Peter
Vilmann
V
Andrian
Saftoiu
S