title: Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses.
abstract: OBJECTIVE
  To evaluate the usefulness of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) in differentiating between pancreatic adenocarcinomas and other pancreatic disease.
  
  
  METHODS
  This retrospective cohort study evaluated 90 patients who were seen between November 2010 and May 2013. All these patients had solid pancreatic masses that had a hypoechoic appearance on EUS. All patients underwent CH-EUS to evaluate this diagnostic method's usefulness. The mass lesions observed on CH-EUS were classified into three categories based on their echo intensity: hypoenhanced, isoenhanced, and hyperenhanced lesions. We adjusted the sensitivity and the specificity of each category for detecting malignancies. We also estimated the accuracy of CH-EUS by comparing it to a pathological diagnosis.
  
  
  RESULTS
  Of the 90 patients, 62 had a pancreatic adenocarcinoma. Fifty-seven out of 62 pancreatic adenocarcinomas showed a hypoenhanced pattern on CH-EUS. The sensitivity was 92%, the specificity 68% and the accuracy approximately 82%. The area under the curve of the receiver operating characteristic analysis for CH-EUS was 0.799. There is a significant association between the hypoenhanced pattern on CH-EUS and pancreatic duct adenocarcinoma (χ(2) = 35.264, P < 0.001). In pathological examinations, the number of specimens for EUS-fine needle aspiration (EUS-FNA) was considered insufficient for diagnosis in three patients, and in two patients, the results were reported to be negative for malignancy. Pancreatic masses in all five patients revealed a hypoenhanced pattern with CH-EUS. Three patients were diagnosed with pancreatic adenocarcinoma based on the pathology results of a biopsy, and the remaining two patients were clinically diagnosed with malignancy.
  
  
  CONCLUSIONS
  CH-EUS is useful for distinguishing between pancreatic adenocarcinoma and other pancreatic disease. When a pancreatic mass shows a hypoenhanced pattern on CH-EUS but involves either insufficient samples or negative results with EUS-FNA, clinicians might consider performing another pathologic diagnosis on the basis of an EUS-FNA sample or a biopsy.
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Park
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Hyung Kil
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Bang
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Sang Gu
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.affiliation: Jin-Seok Park, Hyung Kil Kim, Byoung Wook Bang, Sang Gu Kim, Seok Jeong, Don Haeng Lee, Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology; D016009:Chi-Square Distribution; D003287:Contrast Media; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010743:Phospholipids; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast media; Endoscopic ultrasound; Microbubbles; Pancreas neoplasm; SonoVue