Endoscopy 2011; 43(7): 596-603
DOI: 10.1055/s-0030-1256314
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study

A.  Săftoiu1 , 2 , P.  Vilmann2 , F.  Gorunescu3 , J.  Janssen4 , M.  Hocke5 , M.  Larsen6 , J.  Iglesias-Garcia7 , P.  Arcidiacono8 , U.  Will9 , M.  Giovannini10 , C.  Dietrich11 , R.  Havre12 , C.  Gheorghe13 , C.  McKay14 , D.  I.  Gheonea1 , T.  Ciurea1 , on behalf of the European EUS Elastography Multicentric Study Group
  • 1Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
  • 2Department of Surgical Gastroenterology, Gentofte and Herlev Hospital, University of Copenhagen, Denmark
  • 3Biostatistics and Computer Science, University of Medicine and Pharmacy, Craiova, Romania
  • 4Helios Klinikum, University of Witten/Herdecke, Wuppertal, Germany
  • 5Department of Internal Medicine II, Hospital Meiningen, Germany
  • 6Center for Surgical Ultrasound, Department of Surgery, Odense University Hospital, Odense, Denmark
  • 7Gastroenterology, University Hospital, Santiago de Compostela, Spain
  • 8Gastroenterology and Gastrointestinal Endoscopy Unit, Vita Salute San Raffaele University, Milan, Italy
  • 9Gastroenterology, SRH Wald-Klinikum, Gera, Germany
  • 10Endoscopic Unit, Paoli-Calmettes Institut, Marseilles, France
  • 11Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Germany
  • 12Institute of Medicine, University of Bergen and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
  • 13Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest Romania
  • 14Hepatobiliary Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Further Information

Publication History

submitted 2 August 2010

accepted after revision 21 December 2010

Publication Date:
24 March 2011 (online)

Background and study aims: Endoscopic ultrasound (EUS) elastography represents a new imaging procedure that might characterize the differences of hardness and strain between diseased tissue and normal tissue. The aim of this study was to assess the efficiency of EUS elastography for the differentiation of focal masses in chronic pancreatitis and pancreatic cancer.

Patients and methods: The study group comprised 258 patients with focal pancreatic masses included prospectively at 13 participating centers. Qualitative analysis of the diagnoses made by two expert doctors using all recorded video clips was performed in order to test the interobserver variability. A post-processing software analysis was used to examine the EUS elastography videos by calculating average-hue histograms of individual elastography images. The quantitative information was used to calculate intra-observer variability and the accuracy of the method.

Results: Qualitative analysis of the recorded videos revealed a kappa value of 0.72. Intra-observer variability analysis revealed that the single measure intraclass correlation ranged between 0.86 and 0.94. The average-hue histogram analysis of the data indicated a sensitivity of 93.4 %, a specificity of 66.0 %, a positive predictive value of 92.5 %, a negative predictive value of 68.9 %, and an overall accuracy of 85.4 %, based on a cut-off value of 175. Area under the receiver operating characteristic curve (AUROC) was 0.854 (P < 0.0001) with a confidence interval of 0.804 – 0.894.

Conclusion: The value of quantitative analysis of EUS elastography recordings was proven by good reproducibility of the videos, as well as good parameters of the AUROC analysis. (Clinical Trials.gov identifier: CT00909103).

References

  • 1 Harewood G C, Wiersema M J. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses.  Am J Gastroenterol. 2002;  97 1386-1391
  • 2 Eloubeidi M A, Chen V K, Eltoum I A et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications.  Am J Gastroenterol. 2003;  98 2663-2668
  • 3 Fritscher-Ravens A, Brand L, Knöfel W T et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis.  Am J Gastroenterol. 2002;  97 2768-2775
  • 4 Varadarajulu S, Tamhane A, Eloubeidi M A. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis.  Gastrointest Endosc. 2005;  62 728-736
  • 5 Krishna N B, Mehra M, Reddy A V, Agarwal B. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics.  Gastrointest Endosc. 2009;  70 70-79
  • 6 Ardengh J C, Lopes C V, de Lima L F et al. Cell block technique and cytological smears for the differential diagnosis of pancreatic neoplasms after endosonography-guided fine-needle aspiration.  Acta Gastroenterol Latinoam. 2008;  38 246-251
  • 7 Yusuf T E, Ho S, Pavey D A et al. Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience.  Endoscopy. 2009;  41 445-448
  • 8 Möller K, Papanikolaou I S, Toermer T et al. EUS-guided FNA of solid pancreatic masses: high yield of 2 passes with combined histologic-cytologic analysis.  Gastrointest Endosc. 2009;  70 60-69
  • 9 Fritscher-Ravens A, Izbicki J R, Sriram P V et al. Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery.  Am J Gastroenterol. 2000;  95 2255-2260
  • 10 Touchefeu Y, Le Rhun M, Coron E et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy.  Aliment Pharmacol Ther. 2009;  30 1070-1077
  • 11 Frey H. Real-time elastography. A new ultrasound procedure for the reconstruction of tissue elasticity.  Der Radiologe. 2003;  43 850-855
  • 12 Săftoiu A, Vilman P. Endoscopic ultrasound elastography – a new imaging technique for the visualization of tissue elasticity distribution.  J Gastrointest Liver Dis. 2006;  15 161-165
  • 13 Giovannini M, Hookey L C, Bories E et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients.  Endoscopy. 2006;  38 344-348
  • 14 Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasability and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions.  Gastrointest Endosc. 2007;  65 971-978
  • 15 Hirche T O, Ignee A, Barreiros A P et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions.  Endoscopy. 2008;  40 910-917
  • 16 Săftoiu A, Vilmann P, Gorunescu F et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer.  Gastrointest Endosc. 2008;  68 1086-1094
  • 17 Iglesias-Garcia J, Larino-Noia J, Abdulkader I et al. EUS elastography for the characterization of solid pancreatic masses.  Gastrointest Endosc. 2009;  70 1101-1108
  • 18 Giovannini M, Botelberge T, Bories E et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study.  World J Gastroenterol. 2009;  15 1587-1593
  • 19 Chang K J. Maximizing the yield of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2002;  56 S28-S34
  • 20 Vilmann P, Săftoiu A. Endoscopic ultrasound-guided fine needle aspiration biopsy: equipment and technique.  J Gastroenterol Hepatol. 2006;  2 1646-1655
  • 21 Gorunescu F, Gorunescu M, Săftoiu A et al. Competitive/collaborative neural computing system for medical diagnosis in pancreatic cancer detection.  Expert Systems. 2011;  28 33-48
  • 22 Ferreira T, Rasband W. The ImageJ User Guide – Version 1.44. Available from: http://imagej.nih.gov/ij/docs/user-guide.pdf Accessed: January 2011
  • 23 Spier B J, Johnson E A, Gopal D V et al. Predictors of malignancy and recommended follow-up in patients with negative endoscopic ultrasound-guided fine-needle aspiration of suspected pancreatic lesions.  Can J Gastroenterol. 2009;  23 279-286
  • 24 Koch G G. Intraclass correlation coefficient.. In: Kotz S, Johnson N L, eds. Encyclopedia of statistical sciences, 4.. New York: John Wiley & Sons; 1982: 213-217
  • 25 MacLennan R. Interrater reliability with SPSS for Windows 5.0.  The American Statistician. 1993;  47 292-296
  • 26 Cohen J. A coefficient of agreement for nominal scales.  Educational and Psychological Measurement. 1960;  20 37-46
  • 27 Landis J R, Koch G G. The measurement of observer agreement for categorical data.  Biometrics. 1977;  33 159-174
  • 28 Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer.  J Clin Ultrasound. 2009;  37 1-17
  • 29 Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions.  Gastrointest Endosc. 2007;  65 971-978
  • 30 Kloppel G, Detlefsen S, Feyerabend B. Fibrosis of the pancreas: the initial tissue damage and the resulting pattern.  Virchows Arch. 2004;  445 1-8
  • 31 Săftoiu A, Vilmann P, Hassan H et al. Analysis of endoscopic ultrasound elastography used for characterization and differentiation of benign and malignant lymph nodes.  Ultraschall Med. 2006;  27 535-542
  • 32 Wallace M B, Hawes R H, Durkalski V et al. The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers.  Gastrointest Endosc. 2001;  53 294-299
  • 33 Topazian M, Enders F, Kimmey M et al. Interobserver agreement for EUS findings in familial pancreatic-cancer kindreds.  Gastrointest Endosc. 2007;  66 62-67
  • 34 Stevens T, Lopez R, Adler D G et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis.  Gastrointest Endosc. 2010;  71 519-526

A. SăftoiuMD, PhD 

Research Center of Gastroenterology and Hepatology
University of Medicine and Pharmacy Craiova Romania

Str. Măcinului nr. 1
Craiova
Dolj, 200640
Romania

Fax: +40-251-593077

Email: adry@umfcv.ro or adriansaftoiu@aim.com