Endoscopy 2014; 46(05): 373-379
DOI: 10.1055/s-0034-1364969
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial

Rodica Gincul
1  Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
,
Maxime Palazzo
2  Department of Gastroenterology, Beaujon Hospital, Public Assistance Hospitals of Paris, France
,
Bertrand Pujol
3  Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
,
Florence Tubach
4  Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France
,
Laurent Palazzo
5  Department of Gastroenterology, Clinic of Trocadero, Paris, France
,
Christine Lefort
3  Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
,
Fabien Fumex
3  Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
,
Alexandra Lombard
4  Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France
,
Daniel Ribeiro
1  Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
3  Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
,
Monique Fabre
6  Department of Anatomopathology, Gustave Roussy Hospital, Villejuif, France
,
Valerie Hervieu
7  Department of Anatomopathology, Edouard Herriot hospital, Hospices Civils of Lyon, France
,
Michel Labadie
8  Department of Anatomopathology, Jean Mermoz Privat Hospital, Lyon, France
,
Thierry Ponchon
1  Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
,
Bertrand Napoléon
3  Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
,
and the French Society of Gastrointestinal Endoscopy› Author Affiliations
Further Information

Publication History

submitted 24 April 2013

accepted after revision 02 January 2014

Publication Date:
14 February 2014 (eFirst)

Background and study aims: Histology is the gold standard for the diagnosis of pancreatic adenocarcinoma. However, the negative predictive value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis remains low. The aims of this prospective multicenter study were: (1) to compare the performance of contrast-harmonic EUS (CH-EUS) with that of EUS-FNA for the diagnosis of pancreatic adenocarcinoma; (2) to assess the intra- and interobserver concordances of CH-EUS.

Patients and methods: A total of 100 consecutive patients with a solid pancreatic mass of unknown origin were prospectively included at three centers (July 2009 – April 2010). All patients were examined by CH-EUS followed by EUS-FNA. Absence of vascular enhancement at CH-EUS was regarded as a sign for pancreatic adenocarcinoma. The final diagnosis (gold standard) was based on pathological examination (EUS-FNA, surgery) or 12-month follow-up. 

Results: The final diagnoses were: 69 adenocarcinoma, 10 neuroendocrine tumors, 13 chronic pancreatitis, and 8 other lesions. In diagnosing adenocarcinoma, CH-EUS and EUS-FNA had respective accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 95 %, 96 %, 94 %, 97 %, and 91 %, and of 95 %, 93 %, 100 %, 100 %, and 86 % without significant difference. Five false-negative cases with EUS-FNA were correctly classified by CH-EUS. Interobserver agreement (seven endosonographers) was good (kappa 0.66). Intraobserver agreement was good to excellent (kappa 0.76 for junior, 0.90 for senior).

Conclusions: The performance of CH-EUS for the diagnosis of pancreatic adenocarcinoma was excellent. The good intra- and interobserver concordances suggest an excellent reproducibility. CH-EUS could help to guide the choice between surgery and follow-up when EUS-FNA is inconclusive.