Advertisement

Utility of EUS elastography in the diagnosis of gastric subepithelial tumors: a pilot study (with video)

Published:September 17, 2019DOI:https://doi.org/10.1016/j.gie.2019.09.012

      Background and Aims

      EUS elastography is a real-time imaging technique that analyzes tissue elasticity. The aim of this study was to investigate the applicability of quantitative EUS elastography in the differential diagnosis of gastric subepithelial tumors (SETs).

      Methods

      We prospectively registered 41 consecutive patients with gastric SETs and measured their strain ratios with EUS elastography. The strain ratios of gastric SETs were compared with the histopathologic diagnosis.

      Results

      Thirty-one patients (mean age, 51.4 ± 12.6 years) were included in the analysis. The mean size of the SETs was 2.3 ± 0.7 cm. Lipomas had the lowest strain ratio of 1.6 (1.1-2.0), followed by leiomyomas 6.0 (2.0-29.0), ectopic pancreas 11.8 (1.7-29.3), gastrointestinal stromal tumors (GISTs) 51.1 (29.0-67.0), and schwannomas 62.0. With a cut-off value of 22.7, EUS elastography could differentiate GISTs from leiomyomas with sensitivity and specificity of 100% and 94.1%, respectively (P = .001; 95% confidence interval, 0.979-1.000).

      Conclusions

      EUS elastography could be a promising diagnostic adjunct for the assessment of gastric SETs, especially in differentiating GISTs from leiomyomas.

      Graphical abstract

      Abbreviations:

      APC (argon plasma coagulation), CEEUS (contrast-enhanced EUS), EUS-FNB (EUS fine needle biopsy), EUS-TCB (EUS-guided trucut biopsy), GIST (gastrointestinal stromal tumor), IT knife (insulation-tipped knife), ROC (receiver operating characteristic), ROI (region of interest), SET (subepithelial tumor)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sigrist R.M.S.
        • Liau J.
        • Kaffas A.E.
        • et al.
        Ultrasound elastography: review of techniques and clinical applications.
        Theranostics. 2017; 7: 1303-1329
        • Cui X.W.
        • Chang J.M.
        • Kan Q.C.
        • et al.
        Endoscopic ultrasound elastography: current status and future perspectives.
        World J Gastroenterol. 2015; 21: 13212-13224
        • Hwang J.H.
        • Saunders M.D.
        • Rulyak S.J.
        • et al.
        A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses.
        Gastrointest Endosc. 2005; 62: 202-208
        • Kawada N.
        • Tanaka S.
        Elastography for the pancreas: current status and future perspective.
        World J Gastroenterol. 2016; 22: 3712-3724
        • Giovannini M.
        • Hookey L.C.
        • Bories E.
        • et al.
        Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients.
        Endoscopy. 2006; 38: 344-348
        • Giovannini M.
        • Thomas B.
        • Erwan B.
        • et al.
        Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study.
        World J Gastroenterol. 2009; 15: 1587-1593
        • Bayat M.
        • Denis M.
        • Gregory A.
        • et al.
        Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation.
        PLoS One. 2017; 12e0172801
        • Cosgrove D.
        • Barr R.
        • Bojunga J.
        • et al.
        WFUMB guidelines and recommendations on the clinical use of ultrasound elastography: Part 4. Thyroid.
        Ultrasound Med Biol. 2017; 43: 4-26
        • Friedrich-Rust M.
        • Poynard T.
        • Castera L.
        Critical comparison of elastography methods to assess chronic liver disease.
        Nat Rev Gastroenterol Hepatol. 2016; 13: 402-411
        • Terminology and Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine
        Clinical practice guidelines for ultrasound elastography: prostate.
        J Med Ultrason (2001). 2016; 43: 449-455
        • Tsuji Y.
        • Kusano C.
        • Gotoda T.
        • et al.
        Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors: a pilot study.
        Dig Endosc. 2016; 28: 173-178
        • Carrara S.
        • Di Leo M.
        • Grizzi F.
        • et al.
        EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions.
        Gastrointest Endosc. 2018; 87: 1464-1473
        • Gennisson J.L.
        • Deffieux T.
        • Fink M.
        • et al.
        Ultrasound elastography: principles and techniques.
        Diagn Interv Imaging. 2013; 94: 487-495
        • Mekky M.A.
        • Yamao K.
        • Sawaki A.
        • et al.
        Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors.
        Gastrointest Endosc. 2010; 71: 913-919
        • Akahoshi K.
        • Sumida Y.
        • Matsui N.
        • et al.
        Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration.
        World J Gastroenterol. 2007; 13: 2077-2082
        • El Chafic A.H.
        • Loren D.
        • Siddiqui A.
        • et al.
        Comparison of FNA and fine-needle biopsy for EUS-guided sampling of suspected GI stromal tumors.
        Gastrointest Endosc. 2017; 86: 510-515
        • Fernandez-Esparrach G.
        • Sendino O.
        • Sole M.
        • et al.
        Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study.
        Endoscopy. 2010; 42: 292-299
        • Chu C.S.
        Gastrointestinal stromal tumors: how to increase the preoperative endoscopic ultrasonography diagnostic rate.
        J Med Ultrasound. 2018; 26: 177-180
        • Ignee A.
        • Jenssen C.
        • Hocke M.
        • et al.
        Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors.
        Endosc Ultrasound. 2017; 6: 55-60
        • Kim G.H.
        • Kim K.B.
        • Lee S.H.
        • et al.
        Digital image analysis of endoscopic ultrasonography is helpful in diagnosing gastric mesenchymal tumors.
        BMC Gastroenterol. 2014; 14: 7
        • Yegin E.G.
        • Duman D.G.
        Small EUS-suspected gastrointestinal stromal tumors of the stomach: an overview for the current state of management.
        Endosc Ultrasound. 2016; 5: 69-77
        • Kim G.H.
        • Park D.Y.
        • Kim S.
        • et al.
        Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?.
        World J Gastroenterol. 2009; 15: 3376-3381
        • Antonini F.
        • Fusaroli P.
        • Frazzoni L.
        • et al.
        EUS elastography strain ratio in the differential diagnosis of gastrointestinal subepithelial lesions: preliminary results of a multicenter study.
        Endoscopy. 2018; 50: OP170