Aims
The introduction of ancillary techniques, such as contrast enhanced EUS (CHE-EUS), has improved the study of pancreatic lesions. However, the use of contrast agents entails a prolongation of procedure time and additional costs. The innovative ultrasound technique Detective Flow Imaging-EUS (DFI-EUS) has been recently introduced. It allows the study of micro-vascularization without requiring administration of contrast agents. The aim of this study is to assess the role of DFI in defining pancreatic lesion and its agreement with CHE-EUS.
Methods
Prospective, single centre study conducted on consecutive patients who underwent EUS-FNB for solid pancreatic lesion at the Therapeutic Digestive Endoscopy Unit of Campus Biomedico University of Rome. Lesions were classified according to the degree of vascularisation at DFI study into grade 0 absence of vascularisation or hypovascularisation pattern, grade 1 isovascularisation pattern and grade 2 hypervascularisation pattern compared to surrounding parenchyma.
Final diagnosis was based on histopathology, by using needles of 22 Gauge Acquire™ S for tissue acquisition.
Results
From April 2024 to April 2025, 100 patients were enrolled (51% male; mean age 68± 10 years old). The mean size of pancreatic lesions was 29±13 mm and in the majority of cases were located in the head of the pancreas (52%). At DFI-EUS evaluation 11/100 (11%) of lesions were defined grade 1 at DFI, 20/100 (20%) grade 2 and 69/100 (69%) grade 0. After the Sonovue administration, 70% of lesions showed hypoenhancement. In 69% of cases the final diagnosis was adenocarcinoma, 17% neuroendocrine tumour, 8% inflammatory mass and in 6% other neoplasm. Intraclass Coefficient (ICC) between DFI-EUS and CHE-EUS was 88% and Cohen’s Kappa was 0.74.
The sensitivity of DFI in detecting pancreatic adenocarcinoma was 93% (95% CI 84-97%), the specificity was 50% (95%CI 30-70%).
Conclusions
DFI EUS provide a fast evaluation of the micro-vascularization of pancreatic solid lesions. It seems to be an effective technique in characterizing lesions with good concordance with CHE-EUS.