The usefulness of EUS-FNA with contrast-enhanced harmonic imaging of solid pancreatic lesions: A prospective study.

Few studies have investigated endoscopic ultrasound-guided fine-needle aspiration with contrast-enhanced harmonic imaging (EUS-FNA-CHI) for diagnosing and adequately sampling pancreatic lesions. This study aimed to investigate the efficacy of EUS-FNA-CHI compared with that of endoscopic ultrasound-guided fine-needle aspiration with fundamental B mode imaging (EUS-FNA-FBI) for diagnosing solid pancreatic lesions. Consecutive patients with solid pancreatic lesions were enrolled prospectively (UMIN 000024467). Only samples obtained during the first needle pass (EUS-FNA-FBI) and second needle pass (EUS-FNA-CHI) were used to compare the accuracy rate for diagnosing pancreatic lesions and rate of adequate sampling for histological evaluation. In patients with hypo-enhancing lesions on contrast-enhanced harmonic EUS (CH-EUS), subgroup analyses were performed. Patients were classified into those with a heterogeneous area in the whole lesion (whole group), those with a heterogeneous area with a non-enhancing area (non-enhancing group), and those with a heterogeneous area with a homogeneous area (homogeneous group). Ninety-three patients were enrolled. Overall, the rates of adequate sampling and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI (84.9% vs 68.8%, P = 0.003 and 76.5% vs 58.8%, P = 0.011, respectively). The adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI when the mass was > 15 mm. In the non-enhancing and homogeneous groups, the adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI. CH-EUS enables improved observation of pancreatic lesions and helps identify the target of EUS-FNA among different pathological areas of the lesions particularly of > 15 mm.

Itonaga M ，Kitano M ，Kojima F ，Hatamaru K ，Yamashita Y ，Tamura T ，Nuta J ，Kawaji Y ，Shimokawa T ，Tanioka K ，Murata SI ... -  《-》

Conventional versus contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for diagnosis of solid pancreatic lesions: A prospective randomized trial.

Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) has been used to diagnose solid pancreatic lesions (SPLs). The aim of this study was to investigate the efficacy of CEH-EUS-guided fine-needle aspiration (CEH-EUS-FNA) compared with that of conventional EUS-FNA for the diagnosis of SPLs. Forty patients with solid pancreatic lesions who visited Fukushima Medical University between September 2013 and June 2014 were recruited for this prospective study. Twenty patients underwent CEH-EUS-FNA, and 20 patients underwent conventional EUS-FNA. The sampling rate, sensitivity, accuracy, and number of needle passes required to obtain sufficient samples were compared between the two groups. Patient characteristics, sampling rate, accuracy, and sensitivity were not significantly different between the two groups. The final diagnosis of patients who underwent CEH-EUS-FNA was pancreatic cancer in 19 and intraductal papillary mucinous carcinoma in one. Nineteen patients who underwent conventional EUS-FNA were finally diagnosed with pancreatic cancer and one was diagnosed as cancer of the common bile duct. There was a significant difference in the number of needle passes required. A sufficient sample was obtained on one needle pass in 60% (12/20) of CEH-EUS-FNA group compared with 25% (5/20) of the conventional EUS-FNA group. Fewer needle passes were required to obtain samples from solid pancreatic lesions using CEH-EUS-FNA than those required using conventional EUS-FNA. Therefore, CEH-EUS-FNA may be more efficient and safer than conventional EUS-FNA for the diagnosis of solid pancreatic lesions.

Sugimoto M ，Takagi T ，Hikichi T ，Suzuki R ，Watanabe K ，Nakamura J ，Kikuchi H ，Konno N ，Waragai Y ，Watanabe H ，Obara K ，Ohira H ... -  《-》

Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography.

Kitano M ，Kudo M ，Yamao K ，Takagi T ，Sakamoto H ，Komaki T ，Kamata K ，Imai H ，Chiba Y ，Okada M ，Murakami T ，Takeyama Y ... -  《-》

Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses.

Purpose The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses. Patients and Methods In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months' follow-up. Results The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods' results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy. Conclusion CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.

Seicean A ，Badea R ，Moldovan-Pop A ，Vultur S ，Botan EC ，Zaharie T ，Săftoiu A ，Mocan T ，Iancu C ，Graur F ，Sparchez Z ，Seicean R ... -  《-》

A Comparative Study of the Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology (EUS-FNA) versus Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB) in Pancreatic and Non-Pancreatic Lesions.

Yousri M ，Abusinna E ，Tahoun N ，Okasha HH ，El-Habashi AH ... -  《-》