Contrast-enhanced harmonic (CEH) endoscopic ultrasound (EUS) and conventional EUS were found to be comparable in terms of their diagnostic sensitivity for solid pancreatic lesions, according to the results of a study published in Gastrointestinal Endoscopy.
In this multicenter Korean trial, 240 consecutive patients (mean age, 67.30 years) with solid pancreatic lesions were randomly assigned to undergo either CEH-EUS (n=120) as participants in the interventional group or only conventional EUS (n=120) as participants in the control group.
Researchers compared CEH-EUS-guided fine needle aspiration/biopsy with EUS-guided fine needle aspiration/biopsy in terms of their diagnostic sensitivity for solid pancreatic lesions and the optimal number of needle passes for pathologic diagnosis. The researchers indicated they expected CEH-EUS to have a diagnostic sensitivity up to 15% higher than conventional EUS within 1 to 2 needle passes.
Pancreatic malignancies were observed in 90.83% of patients and neuroendocrine tumors were observed in 3.75% of patients. The mean size of lesions was 30.96 (±12.09) mm in the CEH-EUS group and 33.09 (± 16.39 mm) in the conventional EUS group (P =.252). No significant difference was noted between the 2 groups in terms of the fine needle aspiration/biopsy diagnostic sensitivity of malignant solid pancreatic lesions (86.8% vs 91.1%; P =.313).
The CEH-EUS and conventional EUS groups were also comparable in regard to their respective diagnostic sensitivity values (85.8% vs 88.3%; P =.564). Approximately 68.3% of patients had a diagnosis with the first needle pass. The sensitivity rate increased to 86.7% with the third needle pass. Unexpected adverse events were reported by 3 patients in each group.
A limitation of this study was the lack of a consistent protocol for selection of fine needle aspiration or biopsy, as well as the lack of an established protocol for needle selection.
The researchers noted, however, that “with the use of new [fine needle biopsy] needles that have been developed in recent years, the diagnostic rate is expected to improve.”
Cho IR, Jeong SH, Kang H, Kim EJ, Kim YS, Cho JH. Comparison of contrast-enhanced versus conventional EUS-guided fine-needle aspiration/biopsy in diagnosis of solid pancreatic lesions: a randomized controlled trial. Gastrointest Endosc. Published online January 23, 2021. doi:10.1016/j.gie.2021.01.018