Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial.

Published on Jul 10, 2020in Endoscopy10.093
· DOI :10.1055/A-1193-4954
Andrada Seicean18
Estimated H-index: 18
,
Andrada Samarghitan2
Estimated H-index: 2
+ 7 AuthorsRadu Seicean10
Estimated H-index: 10
Sources
Abstract
BACKGROUND  Contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can visualize necrotic areas and vessels inside lesions. CH-EUS findings combined with EUS-guided fine-needle aspiration (EUS-FNA) improves diagnosis in pancreatic solid masses. CH-EUS can also guide EUS-FNA (CH-EUS-FNA), potentially improving the diagnostic rate of EUS-FNA, but such superiority has not been proved in prospective studies. We aimed to assess whether CH-EUS-FNA is superior to standard EUS-FNA for specific diagnosis of solid pancreatic masses and what factors affect the diagnostic rate. METHODS  This randomized controlled study in one tertiary medical academic center included patients with suspected pancreatic solid masses on transabdominal ultrasound or computed tomography (CT) scan. Two passes with a 22-G standard FNA needle were done using EUS-FNA and CH-EUS-FNA in random order, and the visible core obtained was sent for histological analysis. Final diagnosis was based on EUS-FNA or surgical specimen results and on 12-month follow-up by imaging. RESULTS  148 patients were evaluated. EUS-FNA and CH-EUS-FNA showed diagnostic sensitivities of 85.5 % and 87.6 %, respectively (not significantly different) and the combined sensitivity of the two passes was 93.8 %. The false-negative rate was not significantly different when hypoenhanced or hyperenhanced lesions were compared with the EUS-FNA results. No differences were seen for the results related to location, size, tumor stage, chronic pancreatitis features, or presence of biliary plastic stent. CONCLUSIONS  The diagnostic rates for samples obtained using 22-G needles with standard EUS-FNA and CH-EUS-FNA were not statistically significantly different.
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Diagnostic tests are approaches used in clinical practice to identify with high accuracy the disease of a particular patient and thus to provide early and proper treatment. Reporting high-quality results of diagnostic tests, for both basic and advanced methods, is solely the responsibility of the authors. Despite the existence of recommendation and standards regarding the content or format of statistical aspects, the quality of what and how the statistic is reported when a diagnostic test is ass...
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#2David L. Diehl (GHS: Geisinger Health System)H-Index: 29
Last. Amitpal S. Johal (GHS: Geisinger Health System)H-Index: 1
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: Making a tissue diagnosis of pancreatic adenocarcinoma is best accomplished by EUS and fine-needle aspiration (FNA) of the lesion. Typically, a dark, or "hypoechoic" mass will be seen, which presents an obvious target for FNA. For small lesions, computerized tomography (CT) may be negative, but the lesion is still almost always seen on EUS imaging. Rarely, a pancreatic mass will appear isoechoic on EUS imaging. We report three "invisible" pancreatic masses identified only by a cutoff in the pa...
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#1Yasunobu Yamashita (Wakayama Medical University)H-Index: 10
#2Toshio Shimokawa (Wakayama Medical University)H-Index: 25
Last. Masayuki Kitano (Wakayama Medical University)H-Index: 43
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BACKGROUND: Current imaging modalities are limited in their ability to distinguish pancreatic cancer (PC) from non-neoplastic pancreatic lesions. The diagnostic use of contrast-enhanced endoscopic ultrasonography (CE-EUS) has increased, and its utility has been reported. Recently, contrast-enhanced harmonic EUS (CH-EUS) was reported to facilitate imaging of parenchymal perfusion and microvessels in pancreatobiliary diseases, leading to a high diagnostic accuracy for PC. The present meta-analysis...
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#2Junya SatoH-Index: 3
Last. Kinichi HottaH-Index: 28
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Abstract Background/objectives A clear criterion for terminating endoscopic ultrasound fine needle aspiration (EUS-FNA) without rapid on-site evaluation (ROSE) has not been established. However, a possible solution includes gross visual inspection (GVI) of the sample obtained with EUS-FNA. We performed a retrospective study to elucidate the efficacy of GVI for the diagnostic yield of EUS-FNA. Methods Patients who underwent EUS-FNA of a pancreatic mass using a standard 22-G needle from January 20...
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This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer...
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#1Paul S. Sidhu ('KCL': King's College London)H-Index: 65
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The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
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#1Ken Kamata (Kindai University)H-Index: 22
#2Mamoru Takenaka (Kindai University)H-Index: 20
Last. Masatoshi Kudo (Kindai University)H-Index: 119
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Background and Aims EUS-guided FNA (EUS-FNA) is used for the diagnosis of pancreatic adenocarcinoma, but sometimes the method results in a false negative. Occasionally, an avascular area may be observed within the pancreatic adenocarcinoma tumor during contrast-enhanced harmonic EUS (CH-EUS). The aim of this study was to evaluate whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was affected by the presence of avascularity on CH-EUS. Methods Two hundred ninety-two patie...
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#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 29
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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2015, were collected by the Nation...
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#10Silvia Carrara (Humanitas University)H-Index: 15
For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease. Strong recommendation, moderate quality evidence. In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery. Weak recom...
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Over the last decades, contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) has emerged as an important diagnostic tool for the diagnosis and differentiation of several gastrointestinal diseases. The key advantage of CH-EUS is that the influx and washout of contrast in the target lesion can be observed in real time, accurately depicting microvasculature. CH-EUS is established as an evidence-based technique complementary to B-mode EUS to differentiate solid appearing structures, to character...
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#1Ning Pu (Fudan University)H-Index: 10
#2Hanlin Yin (Fudan University)H-Index: 5
Last. Wenhui Lou (Fudan University)H-Index: 22
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Pancreatic cancer is one of the most aggressive diseases in the world due to a lack of early detection, leading to an overall 5-year survival of only 10%. In recent years, clinical trials targeted pancreatic cancer in efforts to improve survival. These studies introduce new technologies, concepts, and evidence which have instilled new optimism for improving prognosis. This review summarizes the current status of the recent (5-year) clinical trials and describes contemporary research on pancreati...
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#2Emil Lou (UMN: University of Minnesota)H-Index: 26
Last. Shounak Majumder (Mayo Clinic)H-Index: 16
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PURPOSE OF REVIEW Pancreatic ductal adenocarcinoma (PDAC) is third leading cause of cancer death in the United States, a lethal disease with no screening strategy. Although diagnosis at an early stage is associated with improved survival, clinical detection of PDAC is typically at an advanced symptomatic stage when best in class therapies have limited impact on survival. RECENT FINDINGS In recent years this status quo has been challenged by the identification of novel risk factors, molecular mar...
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#1Akashi Fujita (Saitama Medical University)H-Index: 6
#2Shomei RyozawaH-Index: 20
Last. Yumi MashimoH-Index: 10
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Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pan...
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#1Tiing Leong Ang (NUS: National University of Singapore)
#2Lai Mun Wang (CGH: Changi General Hospital)
The introduction of endoscopic ultrasound guided fine needle aspiration into clinical practice was a pivotal moment for diagnostic gastrointestinal endoscopy. It facilitated ease of tissue acquisition from previously inaccessible sites. The performance characteristics of cytological diagnosis was excellent. However, there remained areas of inadequacies. These included procedural inefficiencies such as the need for rapid on-site cytological evaluation or macroscopic on-site evaluation, the crucia...
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#1Antonio Facciorusso (University of Foggia)H-Index: 21
#2Babu P. Mohan (UofU: University of Utah)H-Index: 6
Last. Pietro Fusaroli (UNIBO: University of Bologna)H-Index: 28
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OBJECTIVES It is still unclear whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses. Aim of this meta-analysis was to compare the diagnostic outcomes of these two techniques. METHODS We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized controlled trials (recruiting 701 patients). We perform...
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#1Anthony Yuen Bun Teoh (CUHK: The Chinese University of Hong Kong)H-Index: 33
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#2Reiko Ashida (Wakayama Medical University)H-Index: 12
Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful in the differential diagnosis of solid pancreatic lesions, lymph nodes, and liver lesions, inadequate sampling may result in an incorrect pathological diagnosis. The accuracy of EUS for the evaluation of pancreatobiliary lesions may be increased by image enhancement technologies, including contrast-enhanced harmonic (CH)-EUS and EUS-elastography. These methods can provide information that complement EUS-FNA for the ...
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#1Antonio FacciorussoH-Index: 21
#2Christian CotsoglouH-Index: 10
Last. Nicola MuscatielloH-Index: 23
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Background: Whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses remains unclear. The aim of this study was to compare these two techniques on a series of patients with solid pancreatic lesions. Methods: 362 patients underwent EUS-FNA (2008–2019), after the propensity score matching of two groups were compared; 103 treated with CH-EUS-FNA (group 1) and 103...
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