Maxime Palazzo1, Bertrand Napoléon2, Rodica Gincul2, Mathieu Pioche3, Bertrand Pujol2, Christine Lefort2, Fabien Fumex2, Vincent Hautefeuille4, Monique Fabre5, Jérome Cros6, Michèle Felce6, Anne Couvelard7, Alain Sauvanet8, Philippe Lévy9, Philippe Ruszniewski9, Laurent Palazzo10. 1. Beaujon Hospital, Department of Digestive Endoscopy, Assistance Publique Hôpitaux de Paris, Clichy, France. 2. Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France. 3. Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France. 4. Department of Gastroenterology, Amiens-Picardie University Hospital, Amiens, France. 5. Department of Pathology, Gustave Roussy Institute, Villejuif, France. 6. Department of Pathology, Beaujon Hospital, Clichy, France. 7. Department of Pathology, Bichat Hospital, Paris, France. 8. Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital, Clichy, France. 9. Department of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France. 10. Department of Endoscopy, Trocadéro Clinic, Paris, France.
Abstract
BACKGROUND AND AIMS: Contrast harmonic EUS (CH-EUS) has the ability to depict tumor microvasculature. Decreased microvascular density has been identified as a factor associated with tumor aggressiveness. We aimed to study the accuracy of CH-EUS for the prediction of pancreatic neuroendocrine tumor (PNET) aggressiveness. METHODS: Between June 2009 and March 2015, all consecutive patients with histology-proven PNETs and CH-EUS examination were included. Nine endosonographers blindly analyzed all videos. CH-EUS tumor aggressiveness was defined as a heterogeneous enhancement at the early arterial phase. The final diagnosis of tumor aggressiveness was defined as follows: G3 tumors, morphologic and/or histologic findings of metastatic disease in G1/G2 tumors. Diagnostic values were calculated. Intratumoral microvascular density and fibrosis were assessed on pathologic specimens. RESULTS: Eighty-one tumors were included, of which 26 were aggressive (32.1%). In CH-EUS 35 tumors (43.2%) had a heterogeneous enhancement. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CH-EUS for the diagnosis of tumor aggressiveness were 86%, 96%, 82%, 71%, and 98%, respectively. The interobserver agreement among the 9 endosonographers was good (k = .66). The intraobserver agreement was excellent for the junior (κ = .83) and senior (κ = .82) endosonographers. Heterogeneous tumors at CH-EUS corresponded to fewer vascular and more fibrotic tumors (P < .01). CONCLUSIONS: CH-EUS is accurate in the prediction of PNET aggressiveness and could be a decision-making element in their management.
BACKGROUND AND AIMS: Contrast harmonic EUS (CH-EUS) has the ability to depict tumor microvasculature. Decreased microvascular density has been identified as a factor associated with tumor aggressiveness. We aimed to study the accuracy of CH-EUS for the prediction of pancreatic neuroendocrine tumor (PNET) aggressiveness. METHODS: Between June 2009 and March 2015, all consecutive patients with histology-proven PNETs and CH-EUS examination were included. Nine endosonographers blindly analyzed all videos. CH-EUS tumor aggressiveness was defined as a heterogeneous enhancement at the early arterial phase. The final diagnosis of tumor aggressiveness was defined as follows: G3 tumors, morphologic and/or histologic findings of metastatic disease in G1/G2 tumors. Diagnostic values were calculated. Intratumoral microvascular density and fibrosis were assessed on pathologic specimens. RESULTS: Eighty-one tumors were included, of which 26 were aggressive (32.1%). In CH-EUS 35 tumors (43.2%) had a heterogeneous enhancement. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CH-EUS for the diagnosis of tumor aggressiveness were 86%, 96%, 82%, 71%, and 98%, respectively. The interobserver agreement among the 9 endosonographers was good (k = .66). The intraobserver agreement was excellent for the junior (κ = .83) and senior (κ = .82) endosonographers. Heterogeneous tumors at CH-EUS corresponded to fewer vascular and more fibrotic tumors (P < .01). CONCLUSIONS: CH-EUS is accurate in the prediction of PNET aggressiveness and could be a decision-making element in their management.
Authors: Giuseppe Iabichino; Milena Di Leo; Monica Arena; Giovanni Giuseppe Rubis Passoni; Elisabetta Morandi; Francesca Turpini; Paolo Viaggi; Carmelo Luigiano; Luca De Luca Journal: World J Gastroenterol Date: 2022-09-14 Impact factor: 5.374