EUS-EG: Endoscopic Ultrasound Elastography in Pancreatic Masses
Study Details
Study Description
Brief Summary
The aim of the study is to assess elastography during EUS examinations of focal pancreatic masses, and to consequently differentiate benign versus malignant pancreatic masses in a prospective multi-center design.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Ultrasound elastography is a recent ultrasound method used for the calculation of tissue elasticity distribution in real-time. The method allows the reconstruction of tissue elasticity (i.e. the elasticity modulus) and reveals directly the physical properties of the tissue, consequently showing different tissue hardness patterns that are determined by diseases. Tissue elastography can be easily performed real-time with conventional probes, including the linear EUS probes used for the examination of the pancreas. The calculation of tissue elasticity distribution is performed in real-time and the examination results are represented as transparent overlay colour images overimposed on the conventional gray-scale B-mode images.
Ultrasound elastography was previously used for the diagnosis of breast lesions, prostate cancer and thyroid nodules. However, the value of endoscopic ultrasound elastography for the diagnosis of pancreatic focal masses is not clear for the current moment, as some authors couldn't differentiate benign and malignant pancreatic tumors. Moreover, the intense fibrotic reaction and calcifications in chronic pancreatitis induce strain differences, and it is not clear if elastography is sensitive enough to detect them.
The study protocol is based on a semi-quantitative approach of EUS elastography data (movies) consisting of characterization of manually user-defined regions of interest, based on the hue histograms of the individual focal masses. Due to the inherent bias induced by selection of images from a dynamic sequence of EUS elastography, we have previously reported on the utility of using computer-aided diagnosis by averaging images from a dynamic sequence of EUS elastography. A special plugin (based on the ImageJ software, NIH, Bethesda, MD, USA) is used to compute hue histograms on average EUS elastography images, while the hue histograms values for each patient (0 to 255 values) are further used to classify the patients with benign and malignant lesions.
Ultrasound elastography will be performed during an usual EUS examination (7.5 MHz frequency), with two movies of 10 seconds recorded on the embedded HDD in order to minimize variability and to increase repeatability of acquisition. A two panel image with the usual conventional gray-scale B-mode EUS image on the right side and with the elastography image on the left side will be used. The region of interest will be preferably larger than the focal mass, in order to include the surrounding structures. In order to minimize the human bias, all the post-processing and computer analysis of digital movies will be performed within the IT Center in Craiova, with all programmers and statisticians being blinded to the clinical, pathological and imaging data, with the exception of the average hue histogram values calculated from a second region of interest manually traced around the focal mass.
The study design is prospective, blinded and multi-center, comparing endoscopic ultrasound elastography (EUS-EG) results for the detection and characterization of focal pancreatic masses by using artificial intelligence techniques, in comparison with the gold standard represented by pathology. The study will be performed with the approval of the institutional board review of each center.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Pancreatic adenocarcinoma Patients diagnosed with solid pancreatic adenocarcinoma masses, with cytological / histological confirmation |
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| Chronic pancreatitis Patients diagnosed with solid pancreatic tumor masses with all the criteria fulfilled to exclude pancreatic cancer |
Outcome Measures
Primary Outcome Measures
- Value of endoscopic ultrasound elastography for the differential diagnoses of pancreatic masses. [18 months]
Eligibility Criteria
Criteria
Inclusion criteria
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Patients diagnosed with solid pancreatic tumor masses, with cytological / histological confirmation
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Age 18 to 80 years old, men or women
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Signed informed consent for EUS with elastography and FNA biopsy
Exclusion criteria
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Prior surgical treatment with curative intent or chemo-radiotherapy
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Patients diagnosed with mucin producing tumors, pancreatic cystic tumors, etc.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Erasme University | Brussels | Belgium | ||
| 2 | Universite Chatolique Louvain | Brussels | Belgium | ||
| 3 | Gentofte University Hospital | Copenhagen | Denmark | ||
| 4 | University Hospital | Odense | Denmark | ||
| 5 | Institute Paoli Calmettes | Marseille | France | ||
| 6 | Caritas-Krankenhaus | Bad Mergentheim | Germany | ||
| 7 | St. Josef Hospital | Bochum | Germany | ||
| 8 | SRH Klinik | Gera | Germany | ||
| 9 | University Clinic Mainz | Mainz | Germany | ||
| 10 | Dr.Horst-Schmidt-Klinik | Wiesbaden | Germany | ||
| 11 | HELIOS Klinikum Wuppertal, University of Witten/Herdecke | Wuppertal | Germany | ||
| 12 | Hospital San Raffaele | Milan | Italy | ||
| 13 | Erasme Medisch Centrum | Rotterdam | Netherlands | ||
| 14 | University of Haukeland | Bergen | Norway | ||
| 15 | University of Medicine and Pharmacy Craiova | Craiova | Romania | ||
| 16 | University Hospital Santiago | Santiago | Spain | ||
| 17 | Glasgow Royal Infirmary | Glasgow | United Kingdom | ||
| 18 | Newcastle Upon Tyne Hospitals | Newcastle | United Kingdom |
Sponsors and Collaborators
- University of Medicine and Pharmacy Craiova
- University Hospital, Gentofte, Copenhagen
- Odense University Hospital
- Institut Paoli-Calmettes
- San Raffaele University Hospital, Italy
- UCL (Univ), Brussels, Belgium
- Glasgow Royal Infirmary
- Caritas-Krankenhaus Bad Mergentheim
- University of Bergen
- University of Witten/Herdecke
- Newcastle-upon-Tyne Hospitals NHS Trust
Investigators
- Study Director: Adrian Saftoiu, Professor, University of Medicine and Pharmacy Craiova, Romania
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Frey H. [Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity]. Radiologe. 2003 Oct;43(10):850-5. German.
- Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, Yamakawa M, Matsumura T. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006 May;239(2):341-50. Epub 2006 Feb 16.
- Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc. 2007 Jun;65(7):971-8.
- Miyanaga N, Akaza H, Yamakawa M, Oikawa T, Sekido N, Hinotsu S, Kawai K, Shimazui T, Shiina T. Tissue elasticity imaging for diagnosis of prostate cancer: a preliminary report. Int J Urol. 2006 Dec;13(12):1514-8.
- Ophir J, Alam SK, Garra B, Kallel F, Konofagou E, Krouskop T, Varghese T. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H. 1999;213(3):203-33. Review.
- Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007 Aug;92(8):2917-22. Epub 2007 May 29.
- Săftoiu A, Vilmann P, Ciurea T, Popescu GL, Iordache A, Hassan H, Gorunescu F, Iordache S. Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes. Gastrointest Endosc. 2007 Aug;66(2):291-300.
- EUS-EG001
- EUS-EG-UMFCV-RO