Endoscopic ultrasound (EUS) elastography and strain ratio, could it help in differentiating malignant from benign pancreatic lesions?

Evaluating the role of endoscopic ultrasound (EUS) elastography and strain ratio in differentiation between malignant and benign pancreatic lesions.Three hundred twenty-five patients with solid pancreatic lesions were enrolled in this prospective study from 2014 to 2017. EUS real-time elastography scoring and strain ratio were done to all patients and compared to the final diagnosis to assess its sensitivity, specificity, positive and negative predictive values (PPV and NPV) in differentiating malignant from benign lesions.A cut-off value of 4.2 we had sensitivity of 95%, specificity of 63%, PPV of 89%, NPV of 81%, and accuracy of 87%. Another cut-off value of 10.9 showed a sensitivity of 75%, specificity of 88%, PPV of 95%, NPV of 54%, and accuracy of 79%. Adding the elastography to the better cut-off value gave a sensitivity of 97%, specificity of 63%, PPV of 89%, NPV of 88%, and accuracy of 89%.Real-time elastography and strain ration are valuable in differentiating malignant from pancreatic lesions.

Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies.

BACKGROUND/AIMS: Many gastrointestinal tumors appearing as diffuse circumferential malignancies, for example, diffuse signet ring adenocarcinoma and lymphoma, might primarily involve the submucosal layer and hence are difficult to diagnose because they frequently yield negative endoscopic biopsies. This main aim of this study was to evaluate the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies. MATERIALS AND METHODS: This prospective study included 92 patients with diffuse or circumferential gastrointestinal lesions with non-conclusive biopsies that were taken during upper or lower endoscopy. EUS and EUS-FNA were performed on all patients with cytopathological examination. RESULTS: This study included 58 males (63%) and 34 females (37%) with a mean age of 54.2 years. Seventy-two cases (78.3%) were shown to have malignant lesions, and 20 cases (21.7%) were shown to be benign. EUS had a sensitivity of 94.4%, a specificity of 65%, a positive predictive value (PPV) of 90.7%, and a negative predictive value (NPV) of 45.1% with a p<0.0001 in diagnosing malignant lesions. EUS-FNA had a sensitivity of 83%, specificity of 100%, PPV of 100%, and NPV of 61.9% with a p<0.0001. CONCLUSION: Endoscopic ultrasound with EUS-FNA is an accurate procedure in the diagnosis of endoscopic biopsy-negative diffuse or circumferential gastrointestinal lesions.