正常胰腺及胰腺占位病变超声内镜弹性成像特点初步研究

目的 初步探讨正常胰腺及胰腺与位病变的超声内镜弹性成像特征及其在良恶性鉴别中的价值.方法 自2009年1月至6月,对9例胰腺占位病变行EUS的患者同时进行超声内镜实时弹性成像,同时选取6例因其他病变而行EUS者的正常胰腺行超声内镜实时弹性成像作对照,按照弹性成像5分法对组织弹性成像进行评分.结果 9例胰腺占位病变患者最终诊断为胰腺癌4例,囊腺癌1例,囊腺瘤2例,局限性胰腺炎2例,其弹性成像评分：胰腺癌1例3分、3例4分,囊腺癌5分,2例囊腺瘤均为2分,局限性胰腺炎2分和3分各1例;6例正常胰腺者其弹性成像评分1分5例,2分1例.当以1、2分为良性,3～5分为恶性病变的标准进行判断时,超声内镜弹性成像对9例胰腺占位性病变良恶性鉴别有8例准确.结论 胰腺良恶性组织弹性成像呈不同的图像特征,超声内镜实时弹性成像有助于胰腺良恶性病变的鉴别.     

超声量化评分法和超声弹性成像技术诊断甲状腺占位性病变价值分析

目的探讨超声量化评分法和超声弹性成像技术诊断甲状腺占位性病变的临床应用价值。方法选取2014年11月至2017年9月在我院接受甲状腺超声检查及手术治疗的甲状腺占位性病变患者96例(96个甲状腺结节)为研究对象,分别采用超声量化评分法和超声弹性成像技术对患者的甲状腺占位性病变进行良恶性诊断,以病理诊断为金标准,分析这两种检测方法诊断甲状腺占位性病变良恶性的灵敏度、特异性、准确性。结果病理诊断结果显示,96例甲状腺占位性病变患者中,良性病变者66例,恶性病变者30例。超声量化评分法诊断甲状腺占位性病变良恶性的灵敏度、特异性、准确性分别为93.3%、63.6%、72.9%;超声弹性成像诊断甲状腺占位性病变良恶性的灵敏度、特异性、准确性分别为90.0%、81.8%、84.4%。结论超声量化评分法和超声弹性成像技术诊断甲状腺占位性病变的良恶性均具有较高的灵敏度,超声弹性成像诊断的灵敏度、特异性均较高,在临床诊断中具有一定的优势。若能对这两种方法检查的结果结合起来进行综合分析,会进一步提高诊断的准确性。     

超声内镜弹性成像联合血清miR-101-3p,PTX3在胰腺占位性病变中的诊断价值研究

目的 探究超声内镜弹性成像联合血清微小RNA-101-3p(miR-101-3p),正五聚蛋白3(PTX3)在胰腺占位性病变中的诊断价值。方法 选取2020年1月至2023年5月于本院就诊的193例胰腺占位性病变患者为研究对象,对患者进行超声内镜弹性成像检查。qRT-PCR法测定患者血清miR-101-3p水平;酶联免疫吸附法检测血清PTX3水平。ROC曲线分析血清miR-101-3p、PTX3水平对胰腺占位性病变的诊断价值,采用四表格法分析超声内镜弹性成像联合血清miR-101-3p, PTX3在胰腺占位性病变中的诊断价值。结果 组织病理学诊断结果显示,193例胰腺占位性病变患者中胰腺癌患者121例和胰腺良性病变患者72例。胰腺癌患者血清miR-101-3p显著低于良性胰腺占位性病变患者,PTX3水平显著高于良性胰腺占位性病变患者(P<0.05)。ROC曲线结果表明,血清miR-101-3p水平诊断胰腺占位性病变的AUC为0.782,敏感性为63.64%,特异性为86.11%;血清PTX3水平诊断胰腺占位性病变的AUC为0.705,敏感性为45.45%,特异性为87.50%。超...     

超声造影和内镜超声弹性成像在胰腺良恶性疾病鉴别诊断中的应用

胰腺癌是一种病情进展快、恶性程度高、预后极差的消化系统肿瘤,其发病率在世界范围内均呈上升趋势.由于胰腺的解剖位置特殊,发病隐匿,缺乏明显的症状及体征,一旦被发现,50％以上患者已进展为晚期,其5年生存率仅为5％,而早期胰腺癌切除患者的5年生存率可达60％～70％.因此,胰腺癌的早期诊断、临床分期对改善患者预后意义重大.目前,超声造影技术（CEUS）已成为临床上用于胰腺占位性病变诊断较为灵敏的方法,但其定性诊断仍存在困难.近年来出现的内镜超声弹性成像技术多用于乳腺、甲状腺检查,但对胰腺病变鉴别的研究较少.本研究分析胰腺病变的超声造影和内镜超声弹性成像特征,探讨二者联合检查对胰腺良恶性肿瘤鉴别诊断的价值.     

超声弹性成像对乳腺良恶性病变的鉴别诊断价值分析

目的 探讨超声弹性成像对乳腺良恶性病变的鉴别诊断价值.方法 应用超声弹性成像技术对经手术病理学或穿刺组织活检确诊为乳腺肿块的乳腺疾病患者128例进行超声检查,以病理检查结果 作为"金标准",分析超声弹性对乳腺良恶性病变诊断的灵敏度、特异度、准确性、阳性预测值、阴性预测值,并测算弹性成像及灰阶声像图下病灶的长径及面积,测算长径变化率及面积比.结果 超声弹性成像诊断乳腺良恶性病变的敏感度为85.96%,特异度为95.77%,准确率为91.41%,阳性预测值为94.23%,阴性预测值为89.47%;病灶恶性组≥4分的占比为38.28%(49/128),显著高于良性组的2.34%(3/128) (P<0.05);乳腺恶性病灶在灰阶成像及弹性成像中长径、面积测值差异有统计学意义(P<0.05),良性病灶在灰阶成像及弹性成像中长径、面积测值差异不显著(P>0.05),良、恶性组间灰阶成像和弹性成像中的长径变化率、面积比差异有统计学意义(P<0.05).结论 超声弹性成像可以较为准确的判定乳腺肿物的相对弹性硬度,直径变化率及面积比等定量参数对肿物良恶性鉴别具有辅助功能.     

实时超声弹性成像在老年甲状腺恶性结节诊断中的价值

目的探讨实时超声弹性成像技术在老年甲状腺良恶性结节患者诊断中的价值。方法 154例甲状腺病变患者(185个结节)均有超声影像学资料且均经病理证实,其中恶性结节75个,良性结节110个,对比超声弹性成像与病理结果,计算超声弹性成像诊断甲状腺良恶性结节的灵敏度、特异度、准确率等诊断指标。结果 110个良性结节中94个超声弹性成像评级为1~2级,13个3~4级,75个恶性结节中7个评级为1~2级,68个3~4级;甲状腺良、恶性结节超声弹性成像分级差异有统计学意义(P<0.05);与常规超声相比,超声弹性成像诊断甲状腺结节的灵敏度、特异度、阳性阴性预测值及诊断符合率均更好(P<0.05);甲状腺良、恶性结节两组的超声弹性成像图形态、最大直径、包膜情况、边界、钙化情况、回声水平差异有统计学意义(P<0.05)。结论超声弹性成像在鉴别老年甲状腺良恶性结节中具有无创、便捷、准确的优点。     

超声实时弹性成像技术在甲状腺结节鉴别诊断中的价值

目的探讨超声实时弹性成像技术在甲状腺结节鉴别诊断中的价值,为鉴别诊断提供理论依据。方法 148例甲状腺结节患者,共有结节192个,采用超声实时弹性成像技术对患者进行良、恶性结节的诊断分析,分析良、恶性甲状腺结节弹性成像评分、超声弹性应变率(SR)比值及超声弹性SR比值情况。结果良性结节中弹性成像评分以1、2、3分为主,分别为36.36%、27.27%和27.27%;恶性结节易4、5分为主,其比例为51.22%和17.07%;良、恶性结节之间比较差异具有统计学意义(P0.05)。≥4分判断为恶性结节,4分为良性结节;良性结节SR比值为1-3的比例为85.45%,恶性结节SR值2时比例为95.12%,差异具有统计学意义(P0.05)。结论超声实时弹性成像技术在甲状腺结节鉴别诊断中的价值明显,有利于患者治疗,临床价值高。     

超声内镜引导下细针穿刺活检对胰腺占位病变的诊断价值

[目的]通过超声内镜结合细针穿刺活检(EUS-FNA)确定胰腺占位病变的性质,并评价该法对胰腺病变的诊断价值。[方法]入选经影像学检查示胰腺占位病变患者113例,对占位病变行EUS-FNA检查,评价EUSFNA的敏感性、特异性、准确性、阳性预测值、阴性预测值。[结果]113例患者均获得组织学或细胞学标本,穿刺成功率为100.0%。EUS-FNA对于胰腺占位病变诊断的准确性、特异性、敏感性、阳性预测值、阴性预测值分别为:89.4%、100.0%、85.8%、100.0%、33.3%。所有患者均未发生严重并发症。[结论]EUS-FNA对诊断胰腺占位性病变安全、有效,具有重要临床意义。     

超声弹性成像与常规超声诊断肝脏局灶性良恶性病变价值比较

目的 探讨超声弹性成像5分法在肝脏局灶良、恶性病变中的诊断价值。方法 本院2013年8月至2016年2月收治的78例肝脏局灶性良、恶性病变患者,采用常规超声检查和超声弹性成像5分法评定肝脏局灶性病变性质,以手术组织病理学检查为金标准,比较两种超声检查方法的诊断效能。结果 在78例肝脏局灶性病灶患者,经病理学检查诊断为恶性病灶54例,其中胆管细胞癌4例,转移性肝癌11例,肝细胞癌39例,诊断为良性病灶24例,其中肝局灶性结节性增生4例,肝血管瘤9例,肝脓肿11例;常规超声检查诊断恶性病变的灵敏度为75.9%（41/54）,诊断良性病变的特异度为75.0%（18/24）,准确度为75.6%（59/78）,阳性预测值为87.2%（41/47）,阴性预测值为58.1%（18/31）;弹性成像5 分法诊断恶性病变的灵敏度为98.1%（53/54）,诊断良性病变的特异度为79.2%（19/24）,准确度为92.3%（72/78）,阳性预测值为91.4%（53/58）,阴性预测值为95.0%（19/20）。与常规超声检查比,弹性成像的诊断效能较高,差异具有统计学意义（x2=8.050,P=0.005）。结论 在鉴别诊断肝脏局灶性病变性质方面,超声弹性成像5分法比常规超声检查更灵敏和更准确,具有极大的临床应用价值。     

超声弹性成像与二维超声在肝脏病灶良恶性病变中的对比研究

目的探讨超声弹性成像(ultrasound elastography,UE)与二维超声在肝脏病灶良恶性病变中的应用价值。方法选取2012年6月-2014年6月沧州市中心医院收治的168例肝病患者,术前对患者行UE及常规超声检查,并将影像学诊断结果与病理手术结果进行对比。结果 168例患者中,经病理确诊为良性病变68例、恶性病变82例、无病理性改变18例。二维超声诊断良、恶性病变敏感度、特异度、准确度分别为82.35%、88.89%、83.72%和79.27%、72.22%、78.00%;UE诊断良、恶性病变敏感度、特异度、准确度分别为91.18%、88.89%、90.70%和95.12%、88.89%、94.00%。与良性病变患者相比,恶性病变患者弹性成像分级较高,差异有统计学意义(P0.05)。结论 UE技术为肝脏病变诊断及鉴别提供了全新的方法,提高了肝脏良恶性病变的诊断准确性及灵敏性。     

Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: A meta-analysis

Background/AimsEUS elastography is a novel technique that can be used for distinguishing benign from malignant lymph nodes and focal pancreatic masses. However, the studies pertaining to EUS elastography for differential diagnosis of solid pancreatic masses have reported widely varied sensitivities and specificities. A meta-analysis of all relevant articles was performed to estimate the overall diagnostic accuracy of EUS elastography for differentiating benign and malignant solid pancreatic masses.MethodsThe literatures were identified by searching in PubMed and Embase databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve (SROC) also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity.Results13 studies including a total of 1042 patients with solid pancreatic masses were selected for meta-analysis. The pooled sensitivity and specificity of EUS elastography for differentiating benign and malignant solid pancreatic masses were 95% (95% confidence interval [CI], 93%–96%), 69% (95% CI, 63%–75%), respectively. The area under SROC (AUC) was 0.8695. Two significant variables were associated with heterogeneity: color pattern and blinding.ConclusionAs a less invasive modality, EUS elastography is a promising method for differentiating benign and malignant solid pancreatic masses with a high sensitivity, and it can prove to be a valuable supplement to EUS-FNA.     

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses： A multicenter study

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.     

Endoscopic Ultrasound Elastography for Differential Diagnosis of Pancreatic Masses: A Meta-Analysis

Background

Distinguishing malignant from benign pancreatic tumors is challenging with current imaging techniques. Endoscopic ultrasound (EUS) elastography has further improved the efficacy of EUS for characterizing pancreatic lesions.

Aims

To assess, by combining data from existing trials, the accuracy of EUS elastography in diagnosing malignant tumors for patients with pancreatic masses.

Methods

All relevant studies published were identified by systematic searching of databases. A meta-analysis was performed using a random-effects model to combine study results.

Results

Seven studies involving 752 patients were included. The sensitivity of EUS elastography for differential diagnosis of solid pancreatic masses was 97 % (95 % CI, 0.95–0.98), and the specificity was 76 % (95 % CI, 0.69–0.82). The area under the curve under summary receiver operating characteristic (SROC) was 0.9529. The combined positive likelihood ratio was 3.71 (95 % CI, 2.72–5.07), and the negative likelihood ratio was 0.05 (95 % CI, 0.02–0.13).

Conclusion

Our meta-analysis shows that EUS elastography is a useful tool for differential diagnosis of solid pancreatic neoplasms with very high sensitivity and relatively low specificity. The results indicate that EUS elastography not only provides information complementary to that from EUS but also potentially increases the yield of fine needle aspiration and reduces the number of unnecessary biopsies.     

Endoscopic ultrasound elastography in the diagnosis of pancreatic masses: A meta-analysis

Background and aims

Endoscopic ultrasound (EUS) elastography is a novel non-invasive technique that can be used for distinguishing benign from malignant pancreatic masses. However, the studies have reported widely varied sensitivities and specificities. A meta-analysis was performed to assess the performance of EUS elastography for the differentiation of benign and malignant pancreatic masses.

Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer

AIM: To assess quantitative endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophago-gastric cancers.METHODS: This was a single tertiary centre study assessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS characteristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.RESULTS: EUS elastography and FNAB were performed on 53 lymph nodes. Cytological malignancy was found in 23 nodes, one was indeterminate, one was found to be a gastrointestinal stromal tumor and 25 of the nodes were negative for malignancy. On 3 occasions insufficient material was obtained for analysis. The area under the curve for the receiver operating characteristic curve for elastography strain ratio was 0.87 (P < 0.0001). Elastography strain ratio had a sensitivity 83%, specificity 96%, positive predictive value 95%, and negative predictive value 86% for distinguishing between malignant and benign nodes. The overall accuracy of elastography strain ratio was 90%. Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria.CONCLUSION: EUS elastography is a promising modality that may complement standard EUS and help guide EUS-FNAB during staging of upper gastrointestinal tract cancer.     

Role of Endoscopic Ultrasound Elastography Strain Histograms in the Evaluation of Patients with Pancreatic Masses

Background: The Endoscopic Ultrasound (EUS) quantitative elastography strain ratio (SR) and strain histogram (SH) methods for non-invasive pancreatic masses differentiation have been recently developed. The aim of this research was to investigate the accuracy of the diagnostic differentiation methods for patients with pancreatic masses, based on the EUS SR and SH.Methods: This is a prospective study involving 100 cases with pancreatic masses. Patients were classified into 2 groups: group that was diagnosed with pancreatic malignancy with positive histopathology by biopsy obtained by fine-needle aspiration or postoperative pathology (72 patients) and the group diagnosed with pancreatitis with negative pathology and follow-up for at least 1 year (28 patients).Results: Based on the ROC curve, the cut-off point for Mode 1 was set at 97. Values under it showed the presence of malignant pancreatic masses. Mode 1 achieved a sensitivity of 89% and a specificity of 43% with an overall accuracy of 76%. The predictive positive value was 70%, and the predictive negative value was 60%. The cut-off point for SR was set at 3.04, and the values were equal or above the suggested pancreatic malignancy. The SR achieved a sensitivity of 95.83%, a specificity of 61%, with an overall accuracy of 86%. The predictive positive and negative values were 86.2% and 85%, respectively.Conclusion: Mode 1 SH showed good sensitivity in the identification of pancreatic malignant tumors but were disappointingly of low specificity. Higher sensitivity, specificity, and overall accuracy were obtained by using the SR.     

Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA

BACKGROUND: Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential diagnosis between pancreatic cancer and focal pancreatitis, with particular reference to detection of the K-ras point mutation. METHODS: The study included 62 consecutive patients with pancreatic ductal cancer and 15 patients with focal pancreatitis demonstrated as a pancreatic mass lesion by EUS. RESULTS: Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of cytopathologic diagnosis were 82%, 100%, 86%, 100%, and 58%, respectively. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of histopathologic diagnosis were 44%, 100%, 55%, 100%, and 32%, respectively. The K-ras point mutation was found in 74% of pancreatic cancers and 0% of focal pancreatitis lesions. No complication of EUS-guided FNA was observed. CONCLUSIONS: EUS-guided FNA is useful for the differential diagnosis of pancreatic mass lesions caused by pancreatic cancer and focal pancreatitis. Analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA may enhance diagnostic accuracy in indeterminate cases.     

Endoscopic ultrasound elastography: current status and future perspectives

Elastography is a new ultrasound modality that provides images and measurements related to tissue stiffness. Endoscopic ultrasound(EUS) has played an important role in the diagnosis and management of numerous abdominal and mediastinal diseases. Elastography by means of EUS examination can assess the elasticity of tumors in the proximity of the digestive tract that are hard to reach with conventional transcutaneous ultrasound probes, such as pancreatic masses and mediastinal or abdominal lymph nodes, thus improving the diagnostic yield of the procedure. Results from previous studies have promised benefits for EUS elastography in the differential diagnosis of lymph nodes, as well as for assessing masses with pancreatic or gastrointestinal(GI) tract locations. It is important to mention that EUS elastography is not considered a modality that can replace biopsy. However, it may be a useful adjunct, improving the accuracy of EUSfine needle aspiration biopsy(EUS-FNAB) by selecting the most suspicious area to be targeted. Even more, it may be useful for guiding further clinical management when EUS-FNAB is negative or inconclusive. In the present paper we will discuss the current knowledge of EUS elastography, including the technical aspects, along with its applications in the differential diagnosis between benign and malignant solid pancreatic masses and lymph nodes, as well as its aid in the differentiation between normal pancreatic tissues and chronic pancreatitis. Moreover, the emergent indication and future perspectives are summarized, such as the benefit of EUS elastography in EUS-guided fine needle aspiration biopsy, and its uses for characterization of lesions in liver, biliary tract, adrenal glands and GI tract.     

Endoscopic ultrasound elastography strain histograms in the evaluation of patients with pancreatic masses

AIM: To investigate the accuracy of the strain histogram endoscopic ultrasound(EUS)-based method for the diagnostic differentiation of patients with pancreatic masses. METHODS: In a prospective single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms(SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1(over the mass) and Mode 2(over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery(58 patients), and a massforming pancreatitis group with negative cytology and follow-up after 3 and 6 mo(47 patients). All statistical analyses were conducted in SPSS 14.0(SPSS Inc., Chicago, IL, United States).RESULTS: Results were obtained with software for strain histograms with reversed hue scale(0 represents the hardest tissue structure and 255 the softest). Based on the receiver operating characteristics(ROC) curve coordinates, the cut-off point for Mode 1 was set at the value of 86. Values under the cut-off point indicated the presence of pancreatic malignancy. Mode 1 reached 100% sensitivity and 45% specificity with overall accuracy of 66%(95%CI: 61%-66%) in detection of pancreatic malignant tumors among the patients with pancreatic masses. The positive and negative predictive values were 54% and 100%, respectively. The cut-off for the new calculated variable, the SH ratio, was set at the value 1.153 based on the ROC curve coordinates. Values equal or above the cut-off value were indicative of pancreatic malignancy. The SH ratio reached 98% sensitivity, 50% specificity and an overall accuracy of 69%(95%CI: 63%-70%). The positive and negative predictive values were 92% and 100%, respectively.CONCLUSION: SH showed high sensitivity in pancreatic malignant tumor detection but disappointingly low specificity. Slight improvements in specificity and accuracy were achieved using the SH ratio.