title: Diagnostic efficacy of quantitative endoscopic ultrasound elastography for differentiating pancreatic disease.
abstract: OBJECTIVE
  Endoscopic ultrasound elastography (EUS-EG) constitutes a novel imaging procedure that allows for the quantification of tissue stiffness with high degrees of accuracy in pancreatic disease. However, the optimal cut-off and reference strain ratio (SR) value of quantitative EUS-EG for differential diagnosis in patients with pancreatic disease remains unclear. This study aimed to clarify these values of normal pancreas, chronic pancreatitis, or pancreatic cancer in an Asian population.
  
  
  METHODS
  Between December 2014 and November 2015, 398 patients without pancreatic disease, 67 patients with chronic pancreatitis, and 90 patients with pancreatic cancer who underwent EUS were enrolled prospectively. Elastographic evaluation was measured using the quotient B/A (SR value).
  
  
  RESULTS
  The mean SR was 3.78 ± 1.35 for normal pancreas, 8.21 ± 5.16 for chronic pancreatitis, and 21.80 ± 12.23 for pancreatic cancer (P < 0.001). The median SR was 15.14 for mass-forming pancreatitis and 18.00 for pancreatic cancer (P = 0.024). The sensitivity, specificity, and accuracy of the SR were 71.6%, 75.2%, and 74.8%, respectively, for detecting chronic pancreatitis using a cut-off value of 5.62, and were 95.6%, 96.3%, and 96.2%, respectively, for detecting pancreatic cancer using a cut-off value of 8.86.
  
  
  CONCLUSIONS
  We provided reference range SR values for normal pancreas, chronic pancreatitis, and pancreatic cancer, as well as an optimal cut-off value for chronic pancreatitis and pancreatic cancer diagnostic accuracy in an Asian population. Quantitative EUS-EG is a supplementary diagnostic method for identifying pancreatic disease.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Su Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Eui Joo
authors.identifier: http://orcid.org/0000-0001-5573-7083
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Republic of Korea.
authors.forename: Tae Joo
authors.initials: TJ
authors.lastname: Jeon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Yeon Suk
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D002908:Chronic Disease; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity
keywords: chronic pancreatitis; elastography; endoscopic ultrasound; pancreatic cancer