Utility of multiphase contrast enhancement patterns on CEH-EUS for the differential diagnosis of IPMN-derived and conventional pancreatic cancer

Jun Yashika, Eizaburo Ohno, Takuya Ishikawa, Tadashi Iida, Hirotaka Suzuki, Kota Uetsuki, Kenta Yamada, Masakatsu Yoshikawa, Noriaki Gibo, Yoshie Shimoyama, Eri Ishikawa, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami, Yoshiki Hirooka, Hiroki Kawashima, Mitsuhiro Fujishiro

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Intraductal papillary mucinous neoplasm (IPMN) is reported as a high-risk factor for pancreatic cancer (PC) that includes IPMN-derived cancers (IPMC) and the development of invasive pancreatic ductal adenocarcinoma (PDAC) concomitant with IPMN. Since invasive IPMC and PDAC exhibit different oncological behaviors, their differentiation is clinically important. We aimed to investigate the use of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) for the differential diagnosis between invasive IPMC and PDAC. Methods: This study involved 183 consecutive patients with PC (invasive IPMC: 42, PDAC concomitant with IPMN: 9, without IPMN: 132) who underwent CEH-EUS preoperatively. While investigating the patterns, enhanced effects in the solid part of the tumor were compared with those in the surrounding pancreatic parenchyma after administration of Sonazoid® and evaluated as hyperenhanced, isoenhanced, or hypoenhanced. We retrospectively compared the enhanced pattern of CEH-EUS by using multiphasic analysis and clinicopathological factors between invasive IPMC and PDAC. Results: In multiphase evaluations at 20, 40 and 60 s in CEH-EUS, 75.2% (106/141) of PDACs were hypoenhanced (−) at ≥2 of the 3 time points, with significant differences from those of invasive IPMC (P < 0.001). The solid tumor diameter was significantly larger in PDAC than in invasive IPMC, and the tumor stage and preoperative serum carbohydrate antigen 19-9 level were higher. After propensity score matching of stage and solid tumor diameter, contrast enhancement patterns were significantly more persistent in invasive IPMC than in PDAC (P = 0.0013). Conclusions: Multiphase evaluation using CEH-EUS is a useful method for differentiating between invasive IPMC and PDAC.

Original languageEnglish
Pages (from-to)390-396
Number of pages7
JournalPancreatology
Volume21
Issue number2
DOIs
Publication statusPublished - 03-2021

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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