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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Apr 7, 2009; 15(13): 1587-1593
Published online Apr 7, 2009. doi: 10.3748/wjg.15.1587
Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study
Marc Giovannini, Thomas Botelberge, Erwan Bories, Christian Pesenti, Fabrice Caillol, Benjamin Esterni, Geneviève Monges, Paolo Arcidiacono, Pierre Deprez, Robert Yeung, Walter Schimdt, Hanz Schrader, Carl Szymanski, Christoph Dietrich, Pierre Eisendrath, Jean-Luc Van Laethem, Jacques Devière, Peter Vilmann, Adrian Saftoiu
Marc Giovannini, Thomas Botelberge, Erwan Bories, Christian Pesenti, Fabrice Caillol, Benjamin Esterni, Endoscopy Unit, Paoli-Calmettes Institute, Marseille 13400, France
Geneviève Monges, Department of Pathology, Paoli-Calmettes Institute, Marseille 13400, France
Paolo Arcidiacono, Endosonography Unit, Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Hospital, Milan, 68052, Italy
Pierre Deprez, Robert Yeung, Division of Gastroenterology, University Hospital Saint-Luc, B-1200 Brussels, Belgium
Walter Schimdt, Hanz Schrader, Carl Szymanski, Department of Medicine I, University Hospital, D-44801 Bochum, Germany
Christoph Dietrich, Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, D-97980, Germany
Pierre Eisendrath, Jean-Luc Van Laethem, Jacques Devière, Division of Gastroenterology, Erasme Hospital, B-1070 Anderlecht, Brussels, Belgium
Peter Vilmann, Adrian Saftoiu, Department of Surgical Gastroenterology, Gentofte University Hospital, DK-2400 Hellerup, Denmark
Author contributions: Giovannini M and Botelberge T Analyzed the data and performed the statistical study; Pesenti C and Caillol F performed the EUS + Elastography; Monges G was the pathologist; Arcidiacono P, Schimdt W, Schrader H, Szymanski C, Dietrich C, Van Laethem JL, Devière J and Vilmann P included and performed EUS + Elastography; Bories E, Esterni B, Deprez P, Eisendrath P, Yeung R and Saftoiu A performed the interobserver study.
Correspondence to: Marc Giovannini, Endoscopy Unit, Paoli-Calmettes Institute, Marseille 13400, France. giovanninim@wanadoo.fr
Telephone: +33-4-91223568
Fax: +33-4-91223658
Received: December 4, 2008
Revised: March 9, 2009
Accepted: March 16, 2009
Published online: April 7, 2009
AIM: To evaluate the ability of endoscopic ultrasound (EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.
METHODS: A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass (n = 121) or lymph node (n = 101). The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration (EUS-FNA) and/or by surgical pathology. An interobserver study was performed.
RESULTS: The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.
CONCLUSION: EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.
