title: Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma.
abstract: OBJECTIVE
  To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.
  
  
  METHODS
  All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection.
  
  
  RESULTS
  One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS.
  
  
  CONCLUSIONS
  CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Omoto
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Kumpei
authors.initials: K
authors.lastname: Kadosaka
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kamata
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Nisida
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Harwani
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takeyama
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Chiba
authors.affiliation: Takeshi Miyata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Ken Kamata, Hajime Imai, Hiroki Sakamoto, Naoshi Nisida, Yogesh Harwani, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama 589-8511, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced harmonic endoscopic ultrasonography; Endoscopic ultrasonography-fine needle aspiration; Lymph node; Pancreatobiliary carcinoma; Sensitivity and specificity