title: Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA.
abstract: OBJECTIVE
  It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS.
  
  
  METHODS
  We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established.
  
  
  RESULTS
  For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer.
  
  
  CONCLUSIONS
  The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.
authors.affiliation: Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania.
authors.forename: Sevastiţa
authors.initials: S
authors.lastname: Iordache
authors.affiliation: Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania.
authors.forename: Mădălin Ionuţ
authors.initials: MI
authors.lastname: Costache
authors.affiliation: Cytology Laboratory, Pathology Department, Clinical Emergency County Hospital Craiova, Romania.
authors.forename: Carmen Florina
authors.initials: CF
authors.lastname: Popescu
authors.affiliation: Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania.
authors.forename: Costin-Teodor
authors.initials: CT
authors.lastname: Streba
authors.affiliation: Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Cazacu
authors.affiliation: Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark. adrian.saftoiu@umfcv.ro.
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003199:Computer Systems; D003287:Contrast Media; D054459:Elasticity Imaging Techniques / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride