Silvia Carrara1, Milena Di Leo2, Fabio Grizzi3, Loredana Correale4, Daoud Rahal5, Andrea Anderloni1, Francesco Auriemma1, Alessandro Fugazza1, Paoletta Preatoni1, Roberta Maselli1, Cesare Hassan6, Elena Finati1, Benedetto Mangiavillano7, Alessandro Repici2. 1. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy. 2. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy. 3. Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Milan, Italy. 4. Centro di Prevenzione Oncologica, Turin, Italy. 5. Department of Pathology, Humanitas Clinical and Research Center, Milan, Italy. 6. Endoscopic Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 7. Digestive Endoscopy Unit, Humanitas Mater Domini, Varese, Italy.
Abstract
BACKGROUND AND AIMS: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis-based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. METHODS: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. RESULTS: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001). CONCLUSIONS: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.).
BACKGROUND AND AIMS: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis-based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. METHODS: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. RESULTS: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001). CONCLUSIONS: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.).
Authors: Labrinus van Manen; Iris Schmidt; Akin Inderson; Ruben D Houvast; Jurjen J Boonstra; Jouke Dijkstra; Jeanin E van Hooft; Wouter B Nagengast; Dominic J Robinson; Alexander L Vahrmeijer; J Sven D Mieog Journal: Int J Med Sci Date: 2022-01-01 Impact factor: 3.738
Authors: Christoph F Dietrich; Sean Burmeister; Stephan Hollerbach; Paolo Giorgio Arcidiacono; Barbara Braden; Pietro Fusaroli; Michael Hocke; Julio Iglesias-Garcia; Masayuki Kitano; Alberto Larghi; Bertrand Napoleon; Kofi W Oppong; Mihai Rimbas; Adrian Saftoiu; Anand V Sahai; Siyu Sun; Yi Dong; Silvia Carrara; Joo Ha Hwang; Christian Jenssen Journal: Endosc Ultrasound Date: 2020 Sep-Oct Impact factor: 5.628