The role of quantitative contrast-enhanced endoscopic ultrasound in the differential diagnosis of pancreatic solid neoplasms: a proof-of-concept prospective study shifting from subjective to objective.

BACKGROUND AND AIMS: Accurate differentiation of pancreatic solid tumors, including pancreatic neuroendocrine neoplasms (pNENs) and pancreatic ductal adenocarcinomas (PDACs), is crucial because of their distinct prognoses and treatments. Contrast-enhanced endoscopic ultrasound (CE-EUS) assesses vascularization differences but is limited by subjective interpretation and low interobserver agreement. The aim of this article is to evaluate the role of quantitative CE-EUS in differentiating pNENs from PDACs.

METHODS: This observational study included patients with a cytological diagnosis of PDACs or pNENs undergoing CE-EUS from January to June 2024. CE-EUS videos were analyzed using software for objective contrast quantification. Vascular parameters were compared between tumor types using Mann-Whitney U tests and receiver operating characteristic analysis.

RESULTS: Among 73 patients (51 with PDACs/22 with pNENs), pNENs had significantly greater contrast intensity, peak enhancement, and wash-in area under the curve. Receiver operating characteristic curves identified wash-in perfusion index and wash-in rate as the most discriminative parameters, achieving an area under the curve of 96.1% when combined.

CONCLUSIONS: Quantitative CE-EUS appears to enhance pancreatic tumor differentiation by eliminating subjectivity and improving diagnostic accuracy.