Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

Sevastiţa Iordache, Mădălin Ionuţ Costache, Carmen Florina Popescu, Costin-Teodor Streba, Sergiu Cazacu, Adrian Săftoiu

32 Citations (Scopus)


AIMS: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS.

MATERIAL AND METHODS: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established.

RESULTS: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer.

CONCLUSIONS: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.

Original languageEnglish
JournalMedical Ultrasonography
Issue number1
Pages (from-to)18-24
Number of pages7
Publication statusPublished - Mar 2016


  • Adolescent
  • Adult
  • Aged
  • Computer Systems
  • Contrast Media
  • Elasticity Imaging Techniques
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration
  • False Negative Reactions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Observer Variation
  • Pancreatic Neoplasms
  • Phospholipids
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sulfur Hexafluoride
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't


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