Pathological difference of periampullary duodenal neoplasms evaluated by quantitative contrast enhanced harmonic endoscopic ultrasound

Abstract Objectives To date, few studies have investigated the potential application of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) in the diagnosis of periampullary duodenal lesions (PADLs). This study aimed to investigate the diagnostic value of CH-EUS in PADLs and compare parameters of time intensity-curve (TIC) in pathological difference. Methods We enrolled individuals with preliminary assessment as PADLs, and conducted B mode endoscopic ultrasound (B-EUS) and CH-EUS successively. The patients were divided into benign lesion (BL) and malignant lesion (ML) groups according to the pathology. McNemar’s test was used to compare the diagnostic value of these examinations. Differential analysis between BL and ML groups is conducted to find TIC parameters that show a significant difference for pathology prediction. Results 20 PADLs patients were finally included. Echo intensity and uniformity showed no significant difference between the BL and ML groups. In contrast, different modes of blood supply showed statistical significance (p=0.014). Furthermore, 6 parameters including the differences in intensity gain (ΔI gain ; p<0.001), time used from basic to peak status (|ΔT peak |; p=0.027), rate of elevation (ER; p<0.001), the velocity of elevation (ΔVE; p<0.001) and decrease within 90 s (ΔVD 2 ; p=0.041) between neoplasm and control tissue, and the AUC during the wash-in period of lesion tissue (WiAUC (lesion); p=0.043) differed from BL group to ML group. The diagnostic efficacy of CH-EUS TIC quantitative data for PADLs was: sensitivity 88.9 %, specificity 100 %, PPV 100 %, NPV 91.70 %, and accuracy 95 %. Conclusions The quantitative TIC parameters from CH-EUS were of great significance in the pathology difference of PADLs, and demonstrated promising potential as a complementary clinical diagnostic approach.