title: Combination of EUS-FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: A prospective single-blinded study.
abstract: BACKGROUND
  Negative results of EUS-FNA for solid pancreatic lesions (SPL) can be false ones. Combination with strain ratio (SR) may ensure a correct benign diagnosis of SPL.
  
  
  OBJECTIVE
  We prospectively evaluated the sensitivity rate of EUS-FNA and EUS elastography using the strain ratio method for diagnosing SPL.
  
  
  METHODS
  Thirty-eight patients with SPL identified by CT or MRI between January 2013 and November 2013 were included in our prospective study. EUS diagnoses were made using SR by an endosonographer who was blinded to all clinical information. In SPL with adequate cellularity, the results of EUS-FNA were combined with strain ratio to diagnose SPL and the diagnostic value was calculated.
  
  
  RESULTS
  Benign SPL were diagnosed in nine patients with surgical or guided-biopsy pathology (n = 3) and benign cells from FNA with stable disease during the 12-month follow-up time (n = 6). Using the best cut-off strain ratio level at 3.17, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate of EUS elastography were 86.2%, 66.7%, 89.3%, 60%, and 81.6%, respectively. For the 28 patients who underwent EUS-FNA with results of adequate cellularity; EUS-FNA alone versus combination of results of cytology and SR provided sensitivity, specificity, PPV, NPV, and accuracy rate at 90% versus 95.2, 100% versus 71.4%, 100% versus 90.9%, 80% versus 83.3, and 92.9% versus 89.3%, respectively.
  
  
  CONCLUSIONS
  In this prospective single-blinded study, the negative results of both EUS-FNA and SR were more reliable to exclude malignant SPL. The sensitivity of EUS elastography by SR was not superior to EUS-FNA. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Pradermchai
authors.initials: P
authors.lastname: Kongkam
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Narisorn
authors.initials: N
authors.lastname: Lakananurak
authors.affiliation: Departments of Surgery, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Patpong
authors.initials: P
authors.lastname: Navicharern
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.|Department of Medicine, Police General Hospital, Bangkok, Thailand.
authors.forename: Tanyaporn
authors.initials: T
authors.lastname: Chantarojanasiri
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Khin
authors.initials: K
authors.lastname: Aye
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.affiliation: Departments of Surgery, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Krit
authors.initials: K
authors.lastname: Kritisin
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Phonthep
authors.initials: P
authors.lastname: Angsuwatcharakon
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Satimai
authors.initials: S
authors.lastname: Aniwan
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Rapat
authors.initials: R
authors.lastname: Pittayanon
authors.affiliation: Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Pichet
authors.initials: P
authors.lastname: Sampatanukul
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Pinit
authors.initials: P
authors.lastname: Kullavanijaya
authors.affiliation: Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
mesh_terms: D000368:Aged; D054459:Elasticity Imaging Techniques; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: EUS; EUS-FNA; cancer; elastography; endoscopic ultrasound; endosonography; fine needle aspiration; pancreas; pancreas neoplasm; solid pancreatic mass