Role of Endoscopic Ultrasound Elastography Strain Histograms in the Evaluation of Patients with Pancreatic Masses

Background: The Endoscopic Ultrasound (EUS) quantitative elastography strain ratio (SR) and strain histogram (SH) methods for non-invasive pancreatic masses differentiation have been recently developed. The aim of this research was to investigate the accuracy of the diagnostic differentiation methods for patients with pancreatic masses, based on the EUS SR and SH. Methods: This is a prospective study involving 100 cases with pancreatic masses. Patients were classified into 2 groups: group that was diagnosed with pancreatic malignancy with positive histopathology by biopsy obtained by fine-needle aspiration or postoperative pathology (72 patients) and the group diagnosed with pancreatitis with negative pathology and follow-up for at least 1 year (28 patients). Results: Based on the ROC curve, the cut-off point for Mode 1 was set at 97. Values under it showed the presence of malignant pancreatic masses. Mode 1 achieved a sensitivity of 89% and a specificity of 43% with an overall accuracy of 76%. The predictive positive value was 70%, and the predictive negative value was 60%. The cut-off point for SR was set at 3.04, and the values were equal or above the suggested pancreatic malignancy. The SR achieved a sensitivity of 95.83%, a specificity of 61%, with an overall accuracy of 86%. The predictive positive and negative values were 86.2% and 85%, respectively. Conclusion: Mode 1 SH showed good sensitivity in the identification of pancreatic malignant tumors but were disappointingly of low specificity. Higher sensitivity, specificity, and overall accuracy were obtained by using the SR.