Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 524-535
Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.524
Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value
Miguel Puga-Tejada, Raquel Del Valle, Roberto Oleas, Maria Egas-Izquierdo, Martha Arevalo-Mora, Jorge Baquerizo-Burgos, Jesenia Ospina, Miguel Soria-Alcivar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda
Miguel Puga-Tejada, Raquel Del Valle, Roberto Oleas, Maria Egas-Izquierdo, Martha Arevalo-Mora, Jorge Baquerizo-Burgos, Jesenia Ospina, Miguel Soria-Alcivar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda, Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil 090505, Guayas, Ecuador
Miguel Soria-Alcivar, Universidad de Guayaquil, Guayaquil 090505, Guayas, Ecuador
Author contributions: Puga-Tejada M and Oleas R performed design of the work, acquisition, analysis, and interpretation of data, drafting and critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Del Valle R, Egas-Izquierdo M, Ospina J and Soria-Alcivar M contributed to the acquisition of data for the work, critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Egas-Izquierdo M performed the final database consolidation and encryption; Arevalo-Mora M and Baquerizo-Burgos J contributed to the acquisition and analysis of data, drafting the manuscript, and final approval of the version to be published; Pitanga-Lukashok H contributed to the conception and design of the work, critical revision of the manuscript for important intellectual content, and final approval of the version to be published; Robles-Medranda C contributed to the conception and design of the work, drafting and critical revision of the manuscript for important intellectual content, and final approval of the version to be published.
Institutional review board statement: The Institutional Review Board approved the use and management of the corresponding data, No. 11-01-02103.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Microtech, G-Tech Medical Supply, CREO Medical, EndoSound, and Mdconsgroup. The other authors declare no conflicts of interest.
Data sharing statement: The Institutional Review Board approved the use and management of the corresponding data, and the study was conducted in accordance with the Declaration of Helsinki.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos Robles-Medranda, MD, Chief Physician, Director, Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel R Castillo y, Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Guayas, Ecuador. carlosoakm@yahoo.es
Received: May 24, 2022
Peer-review started: May 24, 2022
First decision: June 27, 2022
Revised: July 15, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 16, 2022
ARTICLE HIGHLIGHTS
Research background

Endoscopic ultrasound (EUS) elastography can be a useful technique for the evaluation of pancreatic masses (PMs) and their associated lymph nodes (LNs) through qualitative (analysis of color maps) and quantitative (assessing the strain ratio).

Research motivation

The accuracy of this technique in differentiating malignant from nonmalignant lesions has only been assessed for masses consisting of solid tissue. For the evaluation of solid-cystic lesions, the suitability of EUS-elastography has not been reported.

Research objectives

To determine the diagnostic accuracy of EUS elastography and the strain ratio (SR) cutoff value for malignant PMs and LNs in a Hispanic cohort.

Research methods

A retrospective study of patients who underwent EUS elastography for PMs between December 2013 and December 2014. A qualitative and quantitative (SR) analysis of PMs and their associated LNs was performed. The accuracy of EUS elastography in identifying malignant PMs and LNs and cutoff value for SR were analyzed. A PM and/or its associated LNs were considered malignant based on histopathological findings from fine-needle aspiration biopsy samples.

Research results

Malignant PMs have a superior median SR compared to nonmalignant lesions (50.4 vs 33.0, respectively) (P < 0.001). When analyzing LNs, there was no statistical significance (SR 30.0 for PMs vs 40.0 for LNs) (P = 0.7182). An SR cutoff value > 21.5 in PMs yielded a 94.2% sensitivity. Meanwhile, an SR cutoff value > 14.0 yielded a 90.9% sensitivity.

Research conclusions

The proposed EUS elastography SR cutoff values have a high sensitivity and specificity for the detection of malignancy.

Research perspectives

Future research evaluating the utility of EUS elastography in Hispanic patients through a prospective, multi-center, controlled trial is necessary to validate our data.