Endoscopic Ultrasound Shear Wave for Assessing Chronic Pancreatitis and Solid Pancreatic Neoplasm: A Nested Case-Control Study

Aims To estimate EUS-guided shear wave elastography (EUS-SW) diagnostic accuracy for chonic pancreatitis (CP) and solid pancreas neoplasms (PN).

Methods Included cases with recent diagnosis of CP or PN undergoing EUS-SW (12/20-11/22); a control group (CG) with cases requiring EUS evaluation for subepithelial lesion. Fatty pancreas score, strain ratio (SR), histogram (SH), and ten EUS-SW elasticity (SWE) measurements and dispersion (SWD) were assessed. SWE/SWD variation was based on quotient among IQR and median. SWE and SWD association was estimated with a MANOVA in <30% variation. SWE and SWD cut-off values were calculated with Youden’s index [1] [2].

Table 1  ANOVA predicted values of endoscopic ultrasound (EUS)-guided shear wave elasticity (SWE) and dispersion (SWD).

Results 88 enrolled cases (37 CG, 14 CP, 37 PN). Fatty pancreas score II and III was similar in CG (37.8%/56.8%) and CP (57.1%/42.9%); there was a significant difference in PN, with a score II, III, and IV of 24.3%, 40.5%, and 29.7%, respectively (p<.001). Median SR was similar among CG (3.6; IQR 2.9 – 4.3) and CP (3.9; IQR 3.6 – 4.7), but significantly different to PN (7.6; IQR 5.3 – 11.1; p<.001). Median SWE and SWD were 10.5 kPa (7.3 – 16.6) and 1.9 [m/s]/kHz (1.6 – 2.4), with a <30% variation in 30.7% and 64.8%, respectively (table 1). Diabetes was associated to higher SWE and SWD (p<.05). Predicted SWE were significantly different among PN vs CG (-13.1; -24.4 to -1.7; p=.0242) ([Fig. 1]). SWE ≥17.4 diagnosed PN with a 75% sensitivity, 91% specificity, 60% PPV and 95% NPV; while SWD ≥2.31 predicted PN with a diagnostic accuracy of 54%, 70%, 35%, 84%, respectively.

Conclusions EUS-SW is a valuable measuring tool for CP and PN diagnostic workups. NCT05095831 ([Fig. 2]).

Fig. 2  

Conflicts of interest

Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, EndoSound, and Mdconsgroup. The other authors declare no conflicts of interest.

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Publication History

Article published online:
14 April 2023