Contrast-enhanced Harmonic Endoscopic Ultrasound Using Time-intensity Curve Analysis Predicts Pathological Grade of Pancreatic Neuroendocrine Neoplasm

Overview

Journal J Med Ultrason (2001)

Specialty Radiology

Date 2019 Aug 5

PMID 31377939

Citations 13

Authors

Saimon Takada

Hironari Kato

Yosuke Saragai

Shinichiro Muro

Daisuke Uchida

Takeshi Tomoda

Kazuyuki Matsumoto

Shigeru Horiguchi

Noriyuki Tanaka

Hiroyuki Okada

Affiliations

Soon will be listed here.

Abstract

Purpose: Histological grading is important for the treatment algorithm in pancreatic neuroendocrine neoplasms (PNEN). The present study examined the efficacy of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) and time-intensity curve (TIC) analysis of PNEN diagnosis and grading.

Methods: TIC analysis was performed in 30 patients using data obtained from CH-EUS, and a histopathological diagnosis was made via EUS-guided fine-needle aspiration or surgical resection. The TIC parameters were analyzed by dividing them into G1/G2 and G3/NEC groups. Then, patients were classified into non-aggressive and aggressive groups and evaluated.

Results: Twenty-six patients were classified as G1/G2, and four as G3/NEC. From the TIC analysis, five parameters were obtained (I: echo intensity change, II: time for peak enhancement, III: speed of contrast, IV: decrease rate for enhancement, and V: enhancement ratio for node/pancreatic parenchyma). Three of these parameters (I, IV, and V) showed high diagnostic performance. Using the cutoff value obtained from the receiver-operating characteristic (ROC) analysis, the correct diagnostic rates of parameters I, IV, and V were 96.7%, 100%, and 100%, respectively, between G1/G2 and G3/NEC. A total of 21 patients were classified into the non-aggressive group, and nine into the aggressive group. Using the cutoff value obtained from the ROC analysis, the accurate diagnostic rates of I, IV, and V were 86.7%, 86.7%, and 88.5%, respectively, between the non-aggressive and aggressive groups.

Conclusion: CH-EUS and TIC analysis showed high diagnostic accuracy for grade diagnosis of PNEN. Quantitative perfusion analysis is useful to predict PNEN grade diagnosis preoperatively.

Citing Articles

Contrast-enhanced harmonic EUS with time-intensity curve analysis useful for diagnosis of pancreatic metastasis from renal cell carcinoma (with videos).

Saima A, Kazumori H, Tsunoda H, Onishi K, Kawashima K Endosc Ultrasound. 2024; 13(3):201-204.

PMID: 39318644 PMC: 11419544. DOI: 10.1097/eus.0000000000000064.

Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases.

Huang J, Fan X, Liu W Diagnostics (Basel). 2023; 13(17).

PMID: 37685350 PMC: 10487217. DOI: 10.3390/diagnostics13172815.

Contrast Enhanced EUS for Predicting Solid Pancreatic Neuroendocrine Tumor Grade and Aggressiveness.

Franchellucci G, Andreozzi M, Carrara S, De Luca L, Auriemma F, Paduano D Diagnostics (Basel). 2023; 13(2).

PMID: 36673049 PMC: 9857765. DOI: 10.3390/diagnostics13020239.

Prediction of Pathological Grades of Pancreatic Neuroendocrine Tumors Based on Dynamic Contrast-Enhanced Ultrasound Quantitative Analysis.

Yang D, Cheng J, Tian X, Zhang Q, Yu L, Qiu Y Diagnostics (Basel). 2023; 13(2).

PMID: 36673048 PMC: 9858178. DOI: 10.3390/diagnostics13020238.

Contrast-Enhanced Harmonic Endoscopic Ultrasound for Diagnosis of the Aggressiveness of Pancreatic Neuroendocrine Neoplasm.

Tamura T, Sugihara Y, Yamazaki H, Koutani H, Tamura T, Tsuda I Diagnostics (Basel). 2022; 12(12).

PMID: 36552995 PMC: 9777008. DOI: 10.3390/diagnostics12122988.

References

Koh Y, Chok A, Zheng H, Tan C, Goh B . A systematic review and meta-analysis of the clinicopathologic characteristics of cystic versus solid pancreatic neuroendocrine neoplasms. Surgery. 2014; 156(1):83-96.e2. DOI: 10.1016/j.surg.2014.03.026. View

Fujimori N, Osoegawa T, Lee L, Tachibana Y, Aso A, Kubo H . Efficacy of endoscopic ultrasonography and endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis and grading of pancreatic neuroendocrine tumors. Scand J Gastroenterol. 2015; 51(2):245-52. DOI: 10.3109/00365521.2015.1083050. View

Palazzo M, Napoleon B, Gincul R, Pioche M, Pujol B, Lefort C . Contrast harmonic EUS for the prediction of pancreatic neuroendocrine tumor aggressiveness (with videos). Gastrointest Endosc. 2018; 87(6):1481-1488. DOI: 10.1016/j.gie.2017.12.033. View

Hasegawa T, Yamao K, Hijioka S, Bhatia V, Mizuno N, Hara K . Evaluation of Ki-67 index in EUS-FNA specimens for the assessment of malignancy risk in pancreatic neuroendocrine tumors. Endoscopy. 2013; 46(1):32-8. DOI: 10.1055/s-0033-1344958. View

Jung E, Clevert D, Schreyer A, Schmitt S, Rennert J, Kubale R . Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors: a prospective controlled two-center study. World J Gastroenterol. 2007; 13(47):6356-64. PMC: 4205454. DOI: 10.3748/wjg.v13.i47.6356. View

Couvelard A, OToole D, Turley H, Leek R, Sauvanet A, Degott C . Microvascular density and hypoxia-inducible factor pathway in pancreatic endocrine tumours: negative correlation of microvascular density and VEGF expression with tumour progression. Br J Cancer. 2004; 92(1):94-101. PMC: 2361752. DOI: 10.1038/sj.bjc.6602245. View

Farrell J, Pang J, Kim G, Tabatabai Z . Pancreatic neuroendocrine tumors: accurate grading with Ki-67 index on fine-needle aspiration specimens using the WHO 2010/ENETS criteria. Cancer Cytopathol. 2014; 122(10):770-8. DOI: 10.1002/cncy.21457. View

Capelli P, Fassan M, Scarpa A . Pathology - grading and staging of GEP-NETs. Best Pract Res Clin Gastroenterol. 2013; 26(6):705-17. DOI: 10.1016/j.bpg.2013.01.003. View

Sugimoto M, Takagi T, Hikichi T, Suzuki R, Watanabe K, Nakamura J . Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading. World J Gastroenterol. 2015; 21(26):8118-24. PMC: 4499355. DOI: 10.3748/wjg.v21.i26.8118. View

10.

Alexiev B, Darwin P, Goloubeva O, Ioffe O . Proliferative rate in endoscopic ultrasound fine-needle aspiration of pancreatic endocrine tumors: correlation with clinical behavior. Cancer. 2009; 117(1):40-5. DOI: 10.1002/cncy.20014. View

11.

Marion-Audibert A, Barel C, Gouysse G, Dumortier J, Pilleul F, Pourreyron C . Low microvessel density is an unfavorable histoprognostic factor in pancreatic endocrine tumors. Gastroenterology. 2003; 125(4):1094-104. DOI: 10.1016/s0016-5085(03)01198-3. View

12.

Cloyd J, Kopecky K, Norton J, Kunz P, Fisher G, Visser B . Neuroendocrine tumors of the pancreas: Degree of cystic component predicts prognosis. Surgery. 2016; 160(3):708-13. DOI: 10.1016/j.surg.2016.04.005. View

13.

Yamamoto N, Kato H, Tomoda T, Matsumoto K, Sakakihara I, Noma Y . Contrast-enhanced harmonic endoscopic ultrasonography with time-intensity curve analysis for intraductal papillary mucinous neoplasms of the pancreas. Endoscopy. 2015; 48(1):26-34. DOI: 10.1055/s-0034-1393563. View

14.

Falconi M, Eriksson B, Kaltsas G, Bartsch D, Capdevila J, Caplin M . ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. Neuroendocrinology. 2016; 103(2):153-71. PMC: 4849884. DOI: 10.1159/000443171. View

15.

Jiang J, Shang X, Zhang H, Ma W, Xu Y, Zhou Q . Correlation between maximum intensity and microvessel density for differentiation of malignant from benign thyroid nodules on contrast-enhanced sonography. J Ultrasound Med. 2014; 33(7):1257-63. DOI: 10.7863/ultra.33.7.1257. View

16.

Zhang Q, Yuan C, Dai W, Tang L, Shi J, Li Z . Evaluating pathologic response of breast cancer to neoadjuvant chemotherapy with computer-extracted features from contrast-enhanced ultrasound videos. Phys Med. 2017; 39:156-163. DOI: 10.1016/j.ejmp.2017.06.023. View

17.

Ito T, Sasano H, Tanaka M, Yoshiyuki Osamura R, Sasaki I, Kimura W . Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol. 2010; 45(2):234-43. DOI: 10.1007/s00535-009-0194-8. View

18.

Wang Y, Li L, Wang Y, Cui N, Zou S, Zhou C . Time-intensity curve parameters in rectal cancer measured using endorectal ultrasonography with sterile coupling gels filling the rectum: correlations with tumor angiogenesis and clinicopathological features. Biomed Res Int. 2014; 2014:587806. PMC: 4036556. DOI: 10.1155/2014/587806. View

19.

Matsubara H, Itoh A, Kawashima H, Kasugai T, Ohno E, Ishikawa T . Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases. Pancreas. 2011; 40(7):1073-9. DOI: 10.1097/MPA.0b013e31821f57b7. View

20.

Kuiper P, Hawinkels L, de Jonge-Muller E, Biemond I, Lamers C, Verspaget H . Angiogenic markers endoglin and vascular endothelial growth factor in gastroenteropancreatic neuroendocrine tumors. World J Gastroenterol. 2011; 17(2):219-25. PMC: 3020376. DOI: 10.3748/wjg.v17.i2.219. View