title: Tumor vessel depiction with contrast-enhanced endoscopic ultrasonography predicts efficacy of chemotherapy in pancreatic cancer.
abstract: OBJECTIVE
  Contrast-enhanced endoscopic ultrasonography (CE-EUS) is a new imaging modality for pancreatic lesions. The aim of this study was to evaluate if CE-EUS is useful for predicting treatment efficacy before pancreatic cancer chemotherapy by assessing intratumoral vessel flow.
  
  
  METHODS
  Thirty-nine patients with unresectable advanced pancreatic cancer underwent CE-EUS before chemotherapy. The patients were divided into 2 groups according to the intratumoral vessel flow observed with CE-EUS: vessel sign-positive and vessel sign-negative groups. Patient prognosis was investigated according to presence or absence of the vessel sign.
  
  
  RESULTS
  Two patients were excluded due to poor visualization of CE-EUS images; therefore, 37 patients were analyzed. Contrast-enhanced EUS revealed positive vessel sign in 20 patients, whereas it revealed negative vessel sign in 17 patients. Both progression-free survival and overall survival were significantly longer in the positive- versus negative vessel sign groups (P = 0.037 and P = 0.027, respectively). Multivariate analysis demonstrated that the positive vessel sign was an independent factor associated with longer overall survival (hazard ratio, 0.22; 95% confidence interval, 0.08-0.53).
  
  
  CONCLUSIONS
  Evaluation of intratumoral vessel flow by CE-EUS could be useful for predicting efficacy of chemotherapy in patients with pancreatic cancer. Contrast-enhanced EUS could be used before chemotherapy for inoperable pancreatic cancer.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan. yasunobu@wakayama-med.ac.jp
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itonaga
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Maeda
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D001808:Blood Vessels / Q000503:physiopathology; D003287:Contrast Media; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000503:physiopathology; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000188:drug therapy*; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media