Original articleClinical endoscopyDiagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: a prospective, single-center study
Section snippets
Patients and methods
The Freeman Hospital serves as a tertiary referral center of hepatobiliary and pancreatic surgery for the North East region of England with a population of approximately 3.5 million, undertaking approximately 750 pancreaticobiliary EUS procedures per year. EUS, EUS-FNA, and qualitative tissue elastography are standard procedures in clinical practice and are used routinely at our center for the assessment of pancreatic masses. In accordance with the UK National Research Ethics Service
Clinical characteristics
A total of 104 individuals (median age 67 years, 57 males) underwent a total of 111 quantitative EUS elastography assessments of a pancreatic mass (Table 1). Seventeen of the masses (16.3%) proved secondary to pancreatitis (one of which being autoimmune), whereas the remainder were related to malignancy, the final diagnosis being primary pancreatic carcinoma in 71.2%, neuroendocrine tumor in 10.6%, and metastatic cancer in 1.9%. The median mass size was 3 cm, with the most common location being
Discussion
In this prospective external validation study of quantitative EUS elastography for the differentiation of malignant from benign solid pancreatic masses using both SR and mass elasticity analysis, we observed good sensitivity but less favorable specificity, NPV, overall accuracy and diagnostic discrimination than those originally reported by Iglesias-Garcia et al.17 Re-deriving the optimal cutoff values from our cohort resulted in a modest improvement in overall accuracy. The suboptimal
Conclusion
We report herein the largest single-center study of quantitative EUS elastography in the differential diagnosis of solid pancreatic masses. The accuracy and specificity are less favorable than recently reported, although some improvement in diagnostic performance is achieved when internally derived cutoff points are used. We believe that this technique is likely to supplement rather than replace the role of pancreatic tissue sampling in the future.
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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
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