title: Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial.
abstract: OBJECTIVE
  Histology is the gold standard for the diagnosis of pancreatic adenocarcinoma. However, the negative predictive value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis remains low. The aims of this prospective multicenter study were: (1) to compare the performance of contrast-harmonic EUS (CH-EUS) with that of EUS-FNA for the diagnosis of pancreatic adenocarcinoma; (2) to assess the intra- and interobserver concordances of CH-EUS.
  
  
  METHODS
  A total of 100 consecutive patients with a solid pancreatic mass of unknown origin were prospectively included at three centers (July 2009 - April 2010). All patients were examined by CH-EUS followed by EUS-FNA. Absence of vascular enhancement at CH-EUS was regarded as a sign for pancreatic adenocarcinoma. The final diagnosis (gold standard) was based on pathological examination (EUS-FNA, surgery) or 12-month follow-up.
  
  
  RESULTS
  The final diagnoses were: 69 adenocarcinoma, 10 neuroendocrine tumors, 13 chronic pancreatitis, and 8 other lesions. In diagnosing adenocarcinoma, CH-EUS and EUS-FNA had respective accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 95 %, 96 %, 94 %, 97 %, and 91 %, and of 95 %, 93 %, 100 %, 100 %, and 86 % without significant difference. Five false-negative cases with EUS-FNA were correctly classified by CH-EUS. Interobserver agreement (seven endosonographers) was good (kappa 0.66). Intraobserver agreement was good to excellent (kappa 0.76 for junior, 0.90 for senior).
  
  
  CONCLUSIONS
  The performance of CH-EUS for the diagnosis of pancreatic adenocarcinoma was excellent. The good intra- and interobserver concordances suggest an excellent reproducibility. CH-EUS could help to guide the choice between surgery and follow-up when EUS-FNA is inconclusive.
authors: Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France.
authors: Rodica
authors: R
authors: Gincul
authors: Department of Gastroenterology, Beaujon Hospital, Public Assistance Hospitals of Paris, France.
authors: Maxime
authors: M
authors: Palazzo
authors: Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France.
authors: Bertrand
authors: B
authors: Pujol
authors: Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France.
authors: Florence
authors: F
authors: Tubach
authors: Department of Gastroenterology, Clinic of Trocadero, Paris, France.
authors: Laurent
authors: L
authors: Palazzo
authors: Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France.
authors: Christine
authors: C
authors: Lefort
authors: Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France.
authors: Fabien
authors: F
authors: Fumex
authors: Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France.
authors: Alexandra
authors: A
authors: Lombard
authors: Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France.
authors: Daniel
authors: D
authors: Ribeiro
authors: Department of Anatomopathology, Gustave Roussy Hospital, Villejuif, France.
authors: Monique
authors: M
authors: Fabre
authors: Department of Anatomopathology, Edouard Herriot hospital, Hospices Civils of Lyon, France.
authors: Valerie
authors: V
authors: Hervieu
authors: Department of Anatomopathology, Jean Mermoz Privat Hospital, Lyon, France.
authors: Michel
authors: M
authors: Labadie
authors: Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France.
authors: Thierry
authors: T
authors: Ponchon
authors: Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France.
authors: Bertrand
authors: B
authors: Napoléon
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010743:Phospholipids; D011446:Prospective Studies; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler; D014741:Video Recording
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride