Background: Differential diagnosis between neoplastic and inflammatory pancreatic disease is a medical challenge. Sonoelastography applied endoscopically form images of tissue-strain in soft tissues and may contribute to improved tissue characterisation.
Material and Method: Twenty four patients admitted for evaluation of neoplastic and inflammatory pancreatic disease of unknown histology were examined with a linear echoendoscope (Pentax 3870 UTK) combined with ultrasound scanning with real-time elastography software (Hitachi EUB 8500/Hi vision 900). Inclusion period: 2006-08, 11 women and 13 men. Age: 16-81 years. Histology was obtained from 19 patients as endoscopic ultrasound guided Fine Needle Aspiration (EUS-FNA) or from surgical biopsy or specimen. In five cases we do not have follow up data (3) or the elastogram was inconclusive (2).
Results: Eleven patients had an elastogram showing increased tissue hardness corresponding to a hypoechoic pancreatic lesion on B-Mode scanning. Nine of these patients had malignant disease and 2 had benign disease. In 8 patients, no increased hardness was visualized corresponding to the pancreas and none of these patients have progressed with malignancy during follow up (4-18 months). Based on the 19 patients, EUS elastography has a sensitivity of visualizing malignancy as harder in 9/9 cases (100 %) and a specificity of 8/10 (80%).
Conclusion: EUS Elastography may provide additional information in order to identify malignant lesions in the pancreas. However, distinction between benign and malignant focal lesions remains limited. The Strain-ratio between lesion and normal pancreatic tissue could not separate benign from malignant pancreatic lesions in this material.