Mo1451 The Contrast Enhanced Endoscopic Ultrasound Increases the Diagnostic Accuracy of the Fine Needle Aspiration in Pancreatic Masses

Mo1451 The Contrast Enhanced Endoscopic Ultrasound Increases the Diagnostic Accuracy of the Fine Needle Aspiration in Pancreatic Masses Andrada Seicean*, A.N.C.A. Moldovan-Pop, Adrian Saftoiu, Costin T. Streba, Simona Vultur, Cristian Tefas, Teodora Mocan, Marcel Tantau, Toader Zaharie, Cornel Iancu, Radu Seicean Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; First Surgical Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; Department of Gastroenterology, University of Medicine, Craiova, Romania The global accuracy of fine needle aspiration endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85%. The contrast agents during EUS may highlight the vessels and the necrotic parts of the pancreatic masses, but their incremental role in diagnosis is not known. Aim: To evaluate whether the guidance of FNA during harmonic contrastenhanced pancreatic endoscopic ultrasound (CEH-EUS) would increase the diagnostic accuracy of EUSFNA in the same pancreatic masses. Methods: In each of the 54 prospectively examined patients with pancreatic masses on CT scan, EUSFNA was performed using a 22 G needle, followed by CEH-EUS using Sonovue. A second cluster of EUS-FNA was performed on contrast image, avoiding vessels and the regions inside the mass considered as necrosis. The final diagnosis was based on the results of EUS-FNA and surgery, or 6 months of follow-up in benign lesions. The pairs of samples obtained during conventional EUS-FNA and CEH-EUS-FNA, were assessed blindely by two pathologists. Perfusion analysis of the contrast image was performed by post-processing of the raw data. Results: The final diagnosis was adenocarcinoma (nZ40), chronic pancreatitis (nZ6),pancreatic metastasis (nZ 3) or another (nZ5). The contrast hypoenhanced homogenous aspect was seen in 92.5% of pancreatic adenocarcinoma, while necrotic area inside mass was seen in 10% of the patients. No complications appeared during procedures. Macroscopically , the cell blocks obtained during CEH-EUS-FNA were significantly larger than those obtained in the conventional EUS-FNA guided group (p!0.01). Microscopically, the diagnostic accuracy increased with 10%. The combination of the quantitative assessment of the contrast image with pathologic results significantly improved the diagnostic accuracy. Conclusions: Although necrotic regions inside pancreatic mass were seen less frequently, the CEH-EUS allows a better orientation of the needle inside the pancreatic lesion and increases the yield of diagnostic, especially in combination with the quantitative CEH-EUS analysis.