title: Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy.
abstract: New technologies in endoscopic ultrasound (EUS) evaluation have been developed because of the need to improve the EUS and EUS-fine needle aspiration (EUS-FNA) diagnostic rate. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of the methods presented. Contrast-enhanced harmonic EUS uses a low mechanical index and highlights slow-flow vascularization. This technique is useful for differentiating solid and cystic pancreatic lesions and assessing biliary neoplasms, submucosal neoplasms and lymph nodes. It is also useful for the discrimination of pancreatic masses based on their qualitative patterns; however, the quantitative assessment needs to be improved. The detection of small solid lesions is better, and the EUS-FNA guidance needs further research. The differentiation of cystic lesions of the pancreas and the identification of the associated malignancy features represent the main indications. Elastography is used to assess tissue hardness based on the measurement of elasticity. Despite its low negative predictive value, elastography might rule out the diagnosis of malignancy for pancreatic masses. Needle confocal laser endomicroscopy offers useful information about cystic lesions of the pancreas and is still under evaluation for use with solid pancreatic lesions of lymph nodes.
authors.affiliation: Andrada Seicean, Ofelia Mosteanu, Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Hatieganu", 400162 Cluj-Napoca, Romania.
authors.forename: Andrada
authors.initials: A
authors.lastname: Seicean
authors.affiliation: Andrada Seicean, Ofelia Mosteanu, Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Hatieganu", 400162 Cluj-Napoca, Romania.
authors.forename: Ofelia
authors.initials: O
authors.lastname: Mosteanu
authors.affiliation: Andrada Seicean, Ofelia Mosteanu, Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Hatieganu", 400162 Cluj-Napoca, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Seicean
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D018291:Cystadenoma, Mucinous / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D018613:Microscopy, Confocal / Q000295:instrumentation / Q000379:methods*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced; Cyst; Elastography; Endomicroscopy; Endosonography; Endosonography-fine needle aspiration; Harmonics; Lymph nodes; Pancreas