Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors

Abstract EN

Objectives.

To investigate the usefulness of contrast-enhanced endoscopic ultrasonography (CE-EUS) for histological differentiation of pancreatic tumors.

Methods.

CE-EUS was performed for consecutive patients having a pancreatic solid lesion, and tumors were classified into three vascular patterns (hypervascular, isovascular, and hypovascular) at two time phases (early-phase and late-phase).

Correlation between vascular patterns and histopathology of resected pancreatic cancer (PC) tissues was ascertained.

Results.

The final diagnoses of 147 examined tumors were PC ( n = 109 ) , inflammatory mass ( n = 11 ) , autoimmune pancreatitis ( n = 9 ) , neuroendocrine tumor ( n = 8 ) , and others ( n = 10 ) .

In late-phase images, 104 of 109 PCs had the hypovascular pattern, for a diagnostic sensitivity and specificity of 94% and 71%, respectively.

Of 28 resected PCs, 10 had isovascular, and 18 hypovascular, patterns on the early-phase image.

Early-phase isovascular PCs were more likely to be differentiated than were early-phase hypovascular PCs (6 well and 4 moderately differentiated versus 3 well, 14 moderately, and 1 poorly differentiated, P = 0.028 ) .

Immunostaining revealed that hypovascular areas of early-phase images reflected heterogeneous tumor cells with fibrous tissue, necrosis, and few vessels.

Conclusion.

CE-EUS could be useful for distinguishing PC from other solid pancreatic lesions and for histological differentiation of PCs.