Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 20; pp. 6252 - 6260
• Main Authors: Harima, Hirofumi, Kaino, Seiji, Shinoda, Shuhei, Kawano, Michitaka, Suenaga, Shigeyuki, Sakaida, Isao
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.05.2015
• Subjects: Adenocarcinoma, Mucinous - diagnostic imaging; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Aged; Area Under Curve; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Carcinoma, Papillary - diagnostic imaging; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Contrast Media; Diagnosis, Differential; Endosonography; Female; Ferric Compounds; Humans; Iron; Male; Middle Aged; Multidetector Computed Tomography; Oxides; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - pathology; Pancreatic Ducts - surgery; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Predictive Value of Tests; Retrospective Studies; Retrospective Study; ROC Curve; Watchful Waiting; Contrast-enhanced endoscopic ultrasonography; Computed tomography; Mural nodules; Endoscopic ultrasonography; Branch duct intraductal papillary mucinous neoplasm
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i20.6252

To elucidate the role of contrast-enhanced endoscopic ultrasonography (CE-EUS) in the diagnosis of branch duct intraductal papillary mucinous neoplasm (BD-IPMN). A total of 50 patients diagnosed with BD-IPMN by computed tomography (CT) and endoscopic ultrasonography (EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules (MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis. Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS (median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BD-IPMN to 93%. Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.