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OC.05.2: EUS-Elastography (Strain Ratio) in the Diagnosis of Solid Pancreatic Lesions: A Prospective Cohort Study
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
men but tissue architecture is essential for accurate pathological assessment, as well. The endosonographer can improve tissue acquisition using the wet suction technique, as pre-flushing the needle with saline to replace the column of air with fluid followed by aspiration. The hybrid suction technique relies on preloading the needle with saline, but having continuous negative pressure with a pre-vacuum syringe to avoid manual intermittent suction. The 20-gauge Procore needle is a specific device for obtaining core tissue with a needle used for cytological sampling. To compare the diagnostic accuracy and core presence of 20G Procore FNB vs. wet technique 19G flex FNA for EUS-guided sampling of the same solid pancreatic and non-pancreatic masses. The accuracy of the EUS-FNB and FNA was determined by comparing the histological and cytological results with the final surgical pathological diagnoses or with the results of a clinical follow-up. Material and methods: 37 cases of EUS-sampling for solid abdominal masses prospectively collected from May 2016 up until now in a tertiary-care medical centre. Presence of histologic core and cytological sampling were evaluated. Median number of passes, technical performance, complications rates were recorded. Results: A total of 37 patients (M, 21) underwent 20G procore FNB and wet 19G FNA, by trangastric or transduodenal access. 21 were pancreatic lesion, 10 in the pancreatic body, 7 in the head, 2 in the uncinate process and 2 in the tail. The extrapancreatic lesions included 4 lymphnodes, 2 periesophageal neoformations, 2 gastric submucosal lesions, 2 in the main biliary duct, 2 retroperitoneal abdominal mass, 1 hepatic neoformation, 1 from the surrenal gland and 1 pulmunary mass. Using 20 G needle, in 29 cases (78.38%) cytological adequacy was obtained, whose 20 (54.05%) containing core tissue. The 19G wet technique allowed 34 (91.89%) cytological samples, with 23 (62.16%) core tissues. Two cases of technical failure using 19G flex needle were reported. Median number of passes was 4, but in case of adequate histological sampling, fist pass was already diagnostic. Final diagnosis included 13 pancreatic ductal adenocarcinoma, 1 cholangiocarcinoma, 1 pulmonary microcitoma, 1 hepatocarcinoma and 4 metastatic nodes, 1 lymphoma, 1 neuroendocrine tumours while 10 samples were negative for malignancies. No Rapid-onsite- evaluation (ROSE) was performed. No immediate neither long- term complications were observed. Conclusions: There was no significant difference in procurement of the histologic core (54.05% vs. 62.16%) between the two cohorts at the preliminary analysis. The 20G Procore needle offers a valid opportunity to obtain histological architecture at EUS evaluation, maintaining a good flexibility, as well.
ultrasound processor EU-ME2 in association with the linear array Olympus GF-UCT-180 series echoendoscopes. Material and methods: Two different areas were selected for SR. Area A was a representative area of the mass and included the biggest possible area of the tumor. Area B was placed in a soft peritumoral normal parenchyma to calculate the parenchymal SR (pSR) and in the GI wall to calculate the wall SR (wSR). The quantitative score of elastography was calculated by the SR method, dividing the non-mass soft tissue area (area B) by the tumoral area (area A). Every time, 3 measures of SR for pSR and wSR were recorded and the mean value for each was calculated and used as final SR result for each lesion. Patients with SPL detected by CT or MRI and confirmed by EUS, with age >18 years, were included. Final diagnosis was made on the basis of EUS-FNA, surgical specimens, or follow up of at least 6 months. Results: Study population included 50 patients: 27 male and 23 female with a mean age 68.8 years (SD 12.3). The mean size of SPL was 26.9mm (SD12.9). The localization was the tail in 4 (8%), body in 16 (32%), neck in 5 (10%), head in 18 (36%), uncinated process in 7 (14%). Forty-two patients underwent EUS-FNA (84%). The final diagnosis based on EUS-FNA results, surgery or follow up was: 37 ductal adenocarcinoma (PDAC), 8 neuroendocrine tumours NET, 5 fibrotic area in pancreatitis. SR was feasible in all patients with both methods, pSR and wSR. The mean pSR of PDAC, NET and non neoplastic SPL was respectively 26.1, 7.5 and 6.8 (p=0.02). The mean wSR of PDAC, NET and non neoplastic SPL was 69.6, 12.5, and 11.9 (p=N.S). The major limitation of this study is the low number of benign masses, but these preliminary data showed the feasibility of the SR calculated with the Olympus EU-ME2 echo-processor and the higher SR values in PDAC. Receiver operating curve analysis of strain ratio for the detection of malignancy yielded an area under the curve of 0.898. Sensitivity and specificity of quantitative elastography for the diagnosis of malignancy, by using a strain ratio of 9 as a cut-off value, were 94.3% (82.8–98.6) and 73.3 (58.7–84.4), respectively. Conclusions: EUS-elastography may add information in the EUS assessment of SPL, especially in the identification of lesion suspected for PDAC.
OC.05.2
F. Antonini ∗,1 , G. Delconte 2 , L. Fuccio 5 , G. De Nucci 3 , C. Fabbri 6 , E. Armellini 4 , L. Frazzoni 5 , A. Fornelli 6 , E. Mandelli 3 , A. Magarotto 2 , P. Occhipinti 4 , E. Masci 2 , G. Manes 3 , G. Macarri 1
EUS-ELASTOGRAPHY (STRAIN RATIO) IN THE DIAGNOSIS OF SOLID PANCREATIC LESIONS: A PROSPECTIVE COHORT STUDY S. Carrara ∗,1 , M. Di Leo 1 , A. Anderloni 1 , P. Preatoni 1 , P. Omodei 1 , L. Poliani 1 , A. Fugazza 1 , A. Zerbi 2 , A. Repici 1 1 Digestive
Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano (Milano), Italy; 2 Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano (Milano), Italy Background and aim: Preoperative diagnosis of solid pancreatic masses (SPL) is a challenging clinical problem. EUS elastography is a non-invasive ultrasound technique that displays the relative stiffness of tissues by taking advantage of the deformation caused by the compression or vibrations of the tissues. The level of hardness of SPL can be evaluated using either a qualitative scores and/or quantitative methods (strain ratio; SR). This single center prospective cohort study aimed to evaluate the feasibility and efficacy of the combination of EUS elastography and SR in the diagnosis of SPL by using the elastography software on the new Olympus compact
OC.05.3 ENDOSCOPIC ULTRASOUND-GUIDED TISSUE SAMPLING WITH A NEW 20G BIOPSY NEEDLE FOR THE CHARACTERIZATION OF GASTROINTESTINAL SUBEPITHELIAL LESIONS: RESULTS OF A PRELIMINARY MULTICENTER STUDY
1 Ospedale Augusto Murri, Fermo, Italy; 2 Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; 3 Asst Rhodense, Garbagnate Milanese, Italy; 4 Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy; 5 Ospedale Sant’Orsola-Malpighi, Bologna, Italy; 6 Ospedale Bellaria-Maggiore, Bologna, Italy
Background and aim: Histological examinations and immunohistochemical stains (IHC) are necessary for the differential diagnosis of gastrointestinal subepithelial lesions (SELs). Endoscopic ultrasoundguided fine needle biopsy (EUS-FNB) is the primary modality in the diagnosis of SELs, but still has limited accuracy. Recently, a new 20 gauge (G) biopsy needle with a core-trap technology (EchoTip ProCore® , Cook Medical) has been developed with a large core size and enhanced flexibility. No data are still available about this new device. The aim of this multicenter study was to determine the feasibility, efficacy and safety of EUS-FNB with the new 20G needle in diagnosing SELs.
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
men but tissue architecture is essential for accurate pathological assessment, as well. The endosonographer can improve tissue acquisition using the wet suction technique, as pre-flushing the needle with saline to replace the column of air with fluid followed by aspiration. The hybrid suction technique relies on preloading the needle with saline, but having continuous negative pressure with a pre-vacuum syringe to avoid manual intermittent suction. The 20-gauge Procore needle is a specific device for obtaining core tissue with a needle used for cytological sampling. To compare the diagnostic accuracy and core presence of 20G Procore FNB vs. wet technique 19G flex FNA for EUS-guided sampling of the same solid pancreatic and non-pancreatic masses. The accuracy of the EUS-FNB and FNA was determined by comparing the histological and cytological results with the final surgical pathological diagnoses or with the results of a clinical follow-up. Material and methods: 37 cases of EUS-sampling for solid abdominal masses prospectively collected from May 2016 up until now in a tertiary-care medical centre. Presence of histologic core and cytological sampling were evaluated. Median number of passes, technical performance, complications rates were recorded. Results: A total of 37 patients (M, 21) underwent 20G procore FNB and wet 19G FNA, by trangastric or transduodenal access. 21 were pancreatic lesion, 10 in the pancreatic body, 7 in the head, 2 in the uncinate process and 2 in the tail. The extrapancreatic lesions included 4 lymphnodes, 2 periesophageal neoformations, 2 gastric submucosal lesions, 2 in the main biliary duct, 2 retroperitoneal abdominal mass, 1 hepatic neoformation, 1 from the surrenal gland and 1 pulmunary mass. Using 20 G needle, in 29 cases (78.38%) cytological adequacy was obtained, whose 20 (54.05%) containing core tissue. The 19G wet technique allowed 34 (91.89%) cytological samples, with 23 (62.16%) core tissues. Two cases of technical failure using 19G flex needle were reported. Median number of passes was 4, but in case of adequate histological sampling, fist pass was already diagnostic. Final diagnosis included 13 pancreatic ductal adenocarcinoma, 1 cholangiocarcinoma, 1 pulmonary microcitoma, 1 hepatocarcinoma and 4 metastatic nodes, 1 lymphoma, 1 neuroendocrine tumours while 10 samples were negative for malignancies. No Rapid-onsite- evaluation (ROSE) was performed. No immediate neither long- term complications were observed. Conclusions: There was no significant difference in procurement of the histologic core (54.05% vs. 62.16%) between the two cohorts at the preliminary analysis. The 20G Procore needle offers a valid opportunity to obtain histological architecture at EUS evaluation, maintaining a good flexibility, as well.
ultrasound processor EU-ME2 in association with the linear array Olympus GF-UCT-180 series echoendoscopes. Material and methods: Two different areas were selected for SR. Area A was a representative area of the mass and included the biggest possible area of the tumor. Area B was placed in a soft peritumoral normal parenchyma to calculate the parenchymal SR (pSR) and in the GI wall to calculate the wall SR (wSR). The quantitative score of elastography was calculated by the SR method, dividing the non-mass soft tissue area (area B) by the tumoral area (area A). Every time, 3 measures of SR for pSR and wSR were recorded and the mean value for each was calculated and used as final SR result for each lesion. Patients with SPL detected by CT or MRI and confirmed by EUS, with age >18 years, were included. Final diagnosis was made on the basis of EUS-FNA, surgical specimens, or follow up of at least 6 months. Results: Study population included 50 patients: 27 male and 23 female with a mean age 68.8 years (SD 12.3). The mean size of SPL was 26.9mm (SD12.9). The localization was the tail in 4 (8%), body in 16 (32%), neck in 5 (10%), head in 18 (36%), uncinated process in 7 (14%). Forty-two patients underwent EUS-FNA (84%). The final diagnosis based on EUS-FNA results, surgery or follow up was: 37 ductal adenocarcinoma (PDAC), 8 neuroendocrine tumours NET, 5 fibrotic area in pancreatitis. SR was feasible in all patients with both methods, pSR and wSR. The mean pSR of PDAC, NET and non neoplastic SPL was respectively 26.1, 7.5 and 6.8 (p=0.02). The mean wSR of PDAC, NET and non neoplastic SPL was 69.6, 12.5, and 11.9 (p=N.S). The major limitation of this study is the low number of benign masses, but these preliminary data showed the feasibility of the SR calculated with the Olympus EU-ME2 echo-processor and the higher SR values in PDAC. Receiver operating curve analysis of strain ratio for the detection of malignancy yielded an area under the curve of 0.898. Sensitivity and specificity of quantitative elastography for the diagnosis of malignancy, by using a strain ratio of 9 as a cut-off value, were 94.3% (82.8–98.6) and 73.3 (58.7–84.4), respectively. Conclusions: EUS-elastography may add information in the EUS assessment of SPL, especially in the identification of lesion suspected for PDAC.
OC.05.2
F. Antonini ∗,1 , G. Delconte 2 , L. Fuccio 5 , G. De Nucci 3 , C. Fabbri 6 , E. Armellini 4 , L. Frazzoni 5 , A. Fornelli 6 , E. Mandelli 3 , A. Magarotto 2 , P. Occhipinti 4 , E. Masci 2 , G. Manes 3 , G. Macarri 1
EUS-ELASTOGRAPHY (STRAIN RATIO) IN THE DIAGNOSIS OF SOLID PANCREATIC LESIONS: A PROSPECTIVE COHORT STUDY S. Carrara ∗,1 , M. Di Leo 1 , A. Anderloni 1 , P. Preatoni 1 , P. Omodei 1 , L. Poliani 1 , A. Fugazza 1 , A. Zerbi 2 , A. Repici 1 1 Digestive
Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano (Milano), Italy; 2 Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano (Milano), Italy Background and aim: Preoperative diagnosis of solid pancreatic masses (SPL) is a challenging clinical problem. EUS elastography is a non-invasive ultrasound technique that displays the relative stiffness of tissues by taking advantage of the deformation caused by the compression or vibrations of the tissues. The level of hardness of SPL can be evaluated using either a qualitative scores and/or quantitative methods (strain ratio; SR). This single center prospective cohort study aimed to evaluate the feasibility and efficacy of the combination of EUS elastography and SR in the diagnosis of SPL by using the elastography software on the new Olympus compact
OC.05.3 ENDOSCOPIC ULTRASOUND-GUIDED TISSUE SAMPLING WITH A NEW 20G BIOPSY NEEDLE FOR THE CHARACTERIZATION OF GASTROINTESTINAL SUBEPITHELIAL LESIONS: RESULTS OF A PRELIMINARY MULTICENTER STUDY
1 Ospedale Augusto Murri, Fermo, Italy; 2 Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; 3 Asst Rhodense, Garbagnate Milanese, Italy; 4 Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy; 5 Ospedale Sant’Orsola-Malpighi, Bologna, Italy; 6 Ospedale Bellaria-Maggiore, Bologna, Italy
Background and aim: Histological examinations and immunohistochemical stains (IHC) are necessary for the differential diagnosis of gastrointestinal subepithelial lesions (SELs). Endoscopic ultrasoundguided fine needle biopsy (EUS-FNB) is the primary modality in the diagnosis of SELs, but still has limited accuracy. Recently, a new 20 gauge (G) biopsy needle with a core-trap technology (EchoTip ProCore® , Cook Medical) has been developed with a large core size and enhanced flexibility. No data are still available about this new device. The aim of this multicenter study was to determine the feasibility, efficacy and safety of EUS-FNB with the new 20G needle in diagnosing SELs.