Diagnostic Value Of Endoscopic Ultrasonography In Digestive System

Part Ⅰ ENDOSCOPIC ULTRASOUND ELASTOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF BENIGN AND MALIGNANT DIGESTIVE SOLID TUMORSObjectives To explore the value of endoscopic ultrasound (EUS) elastography in differential diagnosis of digestive solid tumors. (1) To explore the value of 5 points scoring method under EUS elastography in differential diagnosis of benign and malignant digestive solid tumors. (2) To explore the value of strain ratio in differential diagnosis of benign and malignant digestive solid tumors.Methods 26 patients (32 solid lesions of digestive system) were examined with endoscopic ultrasonography real-time tissue elastography. Stable and satisfactory images could be obtained. (1) Organization elasticity imaging was scored according to the 5 points scoring method of EUS elastography.1 point, lesions and surrounding tissue were completely covered with green.2 points, turquoise mixed lesions area, give priority to with green.3 points, the lesion area was given priority to with blue, and part of the green was seen around it.4 points, Lesions area were completely covered with blue.5 points, Lesions area were completely covered with blue, and around part of the organization was also blue. Lesions area with a score of less than or equal to two points were diagnosed as benign lesions and a score of greater than or equal to three points were diagnosed as malignant lesions. Calculate the sensitivity, specificity and accuracy of 5 points scoring method in differential diagnosis of benign and malignant digestive solid tumors. (2) The lesion area was selected as region of interest (ROI) A, and the same level of the surrounding tissue was selected as ROI B, the values were compared by calculation of the SR, SR= surrounding tissue strain rate B/lesions strain rate A.Results:(1) Lesions area with a score of less than or equal to two points were diagnosed as benign lesions and a score of greater than or equal to three points were diagnosed as malignant lesions. Comparison between group of benign and malignant lesions of ultrasonic elasticity score was statistical significance (P<0.05), The sensitivity, specificity and accuracy of the endoscopic ultrasound elasticity imaging in the diagnosis of digestive malignant tumor were 87.0%,88.9%,87.5% respectively. (2) The SR of benign lesion group and malignant lesion group were ranged from 0.01 to 7.33 and 1.00 to 47.66 respectively, the median SR was 7.39 and 20.07 respectively. SR of benign lesion group was significantly lower than that in malignant lesion group, the difference was statistically significant (P<0.05).Conclusions:(1) Sensitivity, specificity and accuracy for the differentiate the digestive substantial malignant tumors with EUS elastography five points scoring method were high. (2)SR is much more objectively to reflect the degree of hardness and softness of the tumor, and more accurate to the identification of benign and malignant tumor lesions. It prones to misjudge when the elasticity imaging score was three, then use the SR to measure can avoid miscalculation. EUS elastography five points scoring method combined with the SR can effectively reduce or avoid the misdiagnosis.(3) EUS elastography can not replace UES-guided needle puncture suction (fine needle aspiration, FNA), but assist FNA targeted biopsies, and increase the number of positive biopsies, which is helpful to clinical diagnosis. As the effective supplement to conventional ultrasonic endoscope, especially for EUS FNA pathological results negative or not suitable for patients with puncture, and more conducive to clinical diagnosis, this can provide further evidences for clinical diagnosis.Part Ⅱ ANALYSIS OF ENDOSCOPIC ULTRASOUND ELASTOGRAPHY PATTERNS IN PANCREATIC TUMORS AND CHRONIC PANCREATITISObjective:To explore the differentiate diagnosis value by analysis of the characteristics of endoscopic ultrasound elastography patterns in patients with normal pancreas, chronic pancreatitis and pancreatic tumors, and further provide a new method clinically.Methods:10 patients with normal pancreas,10 patients with chronic pancreatitis and 16 patients with pancreatic tumor (11 patients with pancreatic cancer and 5 patients with endocrine tumor), were enrolled in the study according to clinical diagnosis and surgery or EUS FNA pathological findings. All the enrolled patients were performed with common gastroscopy, then the endoscopic ultrasonography examination and endoscopic ultrasound elasticity imaging were carried out, finally, its elastic image characteristics were analyzed and summarized. According to the color of tissue elasticity imaging, we conduct the hardness determine:blue stands for hard, red is soft, green and yellow between blue and red. It was divided into 5 types based on the characteristics of different colors:type Ⅰ, lesions are uniformly green; type Ⅱ, lesions uneven color, alternate with green and blue, giving priority to green; type Ⅲ, lesions uneven color, alternate with green and blue, giving priority to blue; type Ⅳ, the lesions homogeneously blue; type Ⅴ, lesions is given priority to blue, in which mixed with large red or green areas.Results:(1) All patients were successfully completed with the endoscopic ultrasound elasticity examination, no complications related to the procedures happened, and the stability of endoscopic ultrasound elasticity imaging images is satisfactory. (2) Endoscopic ultrasound elasticity imaging features were summarized as follows:Normal pancreas were in type Ⅰ; 8 cases of chronic pancreatitis were in type Ⅱ,2 cases were in type Ⅱ; 9 cases of pancreatic cancer were in type Ⅲ,1 cases were in type Ⅳ,1 case was in type Ⅴ; 5 cases of pancreatic endocrine tumor were in type Ⅳ. (3) Pancreatic tumor and chronic pancreatitis have different elasticity imaging characteristics, the elasticity of pancreatic cancer, pancreatic endocrine tumor image were in type Ⅲ-Ⅴ, prompting the organization was hard, if the pancreatic cancer lesion was bigger, when the cancer organizations within hemorrhage, necrosis foci, it was characterized by type Ⅴ. The elasticity of the image of chronic pancreatitis was basically type Ⅱ. But when the medical history is long, pancreas with calcifications had formed type Ⅲ and prompting organization was relatively hard at this time.Conclusions:(1) All cases were successfully finished with EUS elasticity procedures and no complication happened. The stable and the clear images could be obtained by one experienced endoscopist with high technique and good basis of ultrasonic knowledge. (2) The elastic image characteristics of pancreatic tumor is different from those of chronic pancreatitis. Elastic images of pancreatic tumor were in type Ⅲ～Ⅴ, chronic pancreatitis elastic images were basically in type Ⅱ, with occasional in type Ⅲ, the EUS elastography features contribute to the differential diagnosis of pancreatic cancer and chronic pancreatitis, especially in patients with negative results of EUS FNA or those not suitable with puncture, thus EUS elastography was more helpful in clinical diagnosis and could provide further basis for clinical diagnosis.