The use of contrast enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer

Aim: The aim of this study was to evaluate contrast-enhanced endosonography as a method of differentiating inflammation and pancreatic carcinoma based on perfusion characteristics of microvessels. Patients and

Method: In 192 patients with suspected chronic pancreatitis [age: 64±11 years; sex: f/m 75/117] pancreatic lesions were examined by conventional endoscopic B-mode and Power Doppler ultrasound and contrast enhanced power mode (Hitachi EUB 525, SonoVue®, 2.4ml, Bracco) using the following criteria for malignant lesions: no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue® contrast enhanced technique and no detection of venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable (gold standard EUS-guided fine needle aspiration cytology, operation). The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection, regular appearance of vessels over a distance of at least 20mm after injection of SonoVue® and detection of arterial and venous vessels.

Results: Using conventional EUS-criteria sensitivity was 82.2% and specificity of 87.8% for pancreatic cancer. Using contrast enhanced EUS 108 of 118 patients with malignant pancreatic lesion revealed all criteria (increasing sensitivity to 91.5%). In 70 of 74 patients (specificity 94.6%) with chronic pancreatitis the diagnosis was correctly recognized.