Endoscopy 2018; 50(04): S61
DOI: 10.1055/s-0038-1637207
ESGE Days 2018 oral presentations
20.04.2018 – EUS: diagnostic
Georg Thieme Verlag KG Stuttgart · New York

EUS ELASTOGRAPHY STRAIN RATIO IN THE DIFFERENTIAL DIAGNOSIS OF GASTROINTESTINAL SUBEPITHELIAL LESIONS: PRELIMINARY RESULTS OF A MULTICENTER STUDY

F Antonini
1   Augusto Murry Hospital, Fermo, Italy
,
P Fusaroli
2   Imola Hospital, Imola, Italy
,
L Frazzoni
3   S. Orsola-Malpighi University Hospital, Bologna, Italy
,
V Belfiori
1   Augusto Murry Hospital, Fermo, Italy
,
F Auriemma
4   Humanitas Research Hospital, Digestive Endoscopy Unit, Departement of Gastroenterology, Rozzano (MI), Italy
,
D Rahal
4   Humanitas Research Hospital, Digestive Endoscopy Unit, Departement of Gastroenterology, Rozzano (MI), Italy
,
M Serrani
2   Imola Hospital, Imola, Italy
,
A Lisotti
2   Imola Hospital, Imola, Italy
,
S Giorgini
1   Augusto Murry Hospital, Fermo, Italy
,
L Fuccio
3   S. Orsola-Malpighi University Hospital, Bologna, Italy
,
A Repici
4   Humanitas Research Hospital, Digestive Endoscopy Unit, Departement of Gastroenterology, Rozzano (MI), Italy
,
G Macarri
1   Augusto Murry Hospital, Fermo, Italy
,
S Carrara
4   Humanitas Research Hospital, Digestive Endoscopy Unit, Departement of Gastroenterology, Rozzano (MI), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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    Aims:

    The aim of this study was to assess the efficacy of real-time endoscopic ultrasound elastography (EUS-E) with strain ratio (SR) measurement for the differentiation of gastrointestinal subepithelial lesions (SELs).

    Methods:

    Retrospectively collected data from consecutive patients with SELs evaluated by EUS-E with SR at three centers were analyzed. EUS-E was carried out using the Olympus compact ultrasound processor EU-ME2. Area A included the biggest possible area of the lesion, while area B was selected in the peri-tumoral healthy gastrointestinal wall. The SR was calculated as the quotient of B/A. Every time, 3 measures of SR were recorded and the mean value for each was calculated and used as final SR. The reference standards for the final diagnosis were histology on EUS-guided sampling, surgical specimen or clinical follow-up.

    Results:

    A total of 30 SELs were included. The mean lesion size was 27.4 mm (range 9 – 80 mm). The lesion locations were esophagus (n = 4), stomach (n = 20), duodenum (n = 4) and rectum (n = 2). The final diagnosis of the SELs included 11 GISTs (36.6%), 7 leiomyomas (23.3%), 6 lipomas (20%), 2 neuroendocrine tumors (6.6%), 2 ectopic pancreas (6.6%), 1 schwannoma (3.3%), and 1 MALT (3.3%). The mean SR was 36.49 for GISTs, 9.05 for leiomyomas, 2.25 for lipomas and 0.79 for ectopic pancreas. Receiver operating curve analysis of SR for the detection of GISTs yielded an area under the curve of 0.805. The best cut-off level of SR to differentiate GISTs from leiomyomas was 11.18 with a sensitivity of 81.8% (95% CI: 48.2 – 97.7), specificity of 85.7% (95% CI: 42.1 – 99.6), PPV of 85.7% (95% CI: 55.5 – 99.7), NPV of 90% (95% CI: 34.9 – 96.8).

    Conclusions:

    The preliminary results indicate that EUS-E with SR may improve differential diagnosis of SELs being SRs of GISTs higher than those of benign lesions. The cut-off of 11.18 may be helpful to differentiate between GISTs and leiomyomas.


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