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Ductal adenocarcinoma is the most frequent pancreatic solid lesion and the most common tumor of the pancreas. Given its poor prognosis and the major therapeutic consequences, the discrimination between PA and other pancreatic solid lesions is mandatory. EUS is admitted as the most sensitive imaging procedure for the detection and characterization of pancreatic tumors [1-3]. Nevertheless it remains difficult to differentiate, on morphological features, PA from other solid masses. For 15 years, endoscopic ultrasound fine needle aspiration (EUS-FNA) has demonstrated its efficiency for tissue sampling and cyto-histologic diagnosis of PA. However, the negative predictive value (NPV) for the diagnosis of pancreatic adenocarcinoma (PA) remains low (30-70%) in the published prospective series [4]. So, in case of negative result, the choice between surgery and follow-up remains difficult. Additional criteria to get the decision are then warranted.
The assessment of pancreatic tumor enhancement using ultrasound contrast agents (UCAs) in real time with imaging specific methods seems useful to improve their characterization [4-8] either by contrast-enhanced EUS (CE-EUS) or, more recently, by contrast-enhanced harmonic EUS (CH-EUS).
The aims of this prospective multicenter study is:
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100 patients with a solid pancreatic mass of indeterminate origin must be prospectively included in 3 French centers Exclusion criteria: presence of a cystic component greater than 25 % of the total volume of the lesion, pregnancy, lactation, age <18 years, and usual contraindications to SonoVue® injection.
All EUS procedure will be performed by 5 experienced endosonographers as follows:
Statistical analysis. The McNemar test will be use to compare the CH-EUS performance for the diagnosis of PA to EUS-FNA and final diagnosis. Sensitivity (Se), specificity (Spe), predictive positive value (PPV), negative predictive value (NPV) and accuracy with 95% confidence intervals (95%CI) will be calculate. A p value of 0.05 considered statistically significant. Intra- and interobserver agreements of CH-EUS for the diagnosis of PA will assess using kappa statistics and associated 95% CI. Depending on Kappa values, agreement will considered as minor (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), high (0.61-0.80), or almost perfect (0.81-1.00), beyond chance.
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100 participants in 1 patient group
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Data sourced from clinicaltrials.gov
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