Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions

Hussein Hassan Okasha; Hanane Delsa; Abdelmoneim Alsawaf; Ahmed Morad Hashim; Hani M Khattab; Dalia Abdelfatah; Abeer Abdellatef; Amr Albitar

doi:10.5662/wjm.v13.i4.287

Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions

World J Methodol. 2023 Sep 20;13(4):287-295. doi: 10.5662/wjm.v13.i4.287.

Authors

Hussein Hassan Okasha¹, Hanane Delsa^{2

3}, Abdelmoneim Alsawaf⁴, Ahmed Morad Hashim⁵, Hani M Khattab⁶, Dalia Abdelfatah⁷, Abeer Abdellatef⁵, Amr Albitar⁵

Affiliations

¹ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt. okasha.hussein@gmail.com.
² Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco.
³ Research Unit, Mohammed VI Center for Research and Innovation, Rabat 10100, Morocco.
⁴ Department of Gastroenterology, Barnsley NHS Foundation Trust, Barnsley S75 2EP, United Kingdom.
⁵ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt.
⁶ Department of Pathology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt.
⁷ Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11451, Egypt.

Abstract

Background: Endoscopic ultrasonography (EUS) has become an established method in diagnostic and therapeutic procedures in gastroenterology; however, it has recently gained a growing role in hepatology.

Aim: To evaluate the role of EUS features, strain elastography (SE), and EUS-tissue acquisition in diagnosing hepatic focal lesions (HFLs) that could affect further management.

Methods: This cross-sectional study included 215 patients with pancreatic, biliary, or gastrointestinal malignancies referred for EUS examination. HFLs were identified in 43 patients (20%), and EUS-guided tissue acquisition was performed from these lesions.

Results: EUS features were highly sensitive (100%) but much less specific (57%) in diagnosing HFLs; the overall accuracy was 94%. Real-time elastography was also very sensitive (97%) but less specific (67%) in diagnosing HFLs; however, the overall accuracy was 92%. EUS tissue acquisition was extremely sensitive (100%) and specific (100%), with a 100% overall diagnostic accuracy.

Conclusion: The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs. EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.

Keywords: Elastography; Endoscopic ultrasonography; Fine needle aspiration; Fine needle biopsy; Hepatic focal lesions.