Endoscopic Ultrasound Elastography in Pancreatic Masses

NCT ID: NCT00909103

Last Updated: 2010-01-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

285 participants

Study Classification

OBSERVATIONAL

Study Start Date

2008-06-30

Study Completion Date

2009-12-31

Brief Summary

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The aim of the study is to assess elastography during EUS examinations of focal pancreatic masses, and to consequently differentiate benign versus malignant pancreatic masses in a prospective multi-center design.

Detailed Description

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Ultrasound elastography is a recent ultrasound method used for the calculation of tissue elasticity distribution in real-time. The method allows the reconstruction of tissue elasticity (i.e. the elasticity modulus) and reveals directly the physical properties of the tissue, consequently showing different tissue hardness patterns that are determined by diseases. Tissue elastography can be easily performed real-time with conventional probes, including the linear EUS probes used for the examination of the pancreas. The calculation of tissue elasticity distribution is performed in real-time and the examination results are represented as transparent overlay colour images overimposed on the conventional gray-scale B-mode images.

Ultrasound elastography was previously used for the diagnosis of breast lesions, prostate cancer and thyroid nodules. However, the value of endoscopic ultrasound elastography for the diagnosis of pancreatic focal masses is not clear for the current moment, as some authors couldn't differentiate benign and malignant pancreatic tumors. Moreover, the intense fibrotic reaction and calcifications in chronic pancreatitis induce strain differences, and it is not clear if elastography is sensitive enough to detect them.

The study protocol is based on a semi-quantitative approach of EUS elastography data (movies) consisting of characterization of manually user-defined regions of interest, based on the hue histograms of the individual focal masses. Due to the inherent bias induced by selection of images from a dynamic sequence of EUS elastography, we have previously reported on the utility of using computer-aided diagnosis by averaging images from a dynamic sequence of EUS elastography. A special plugin (based on the ImageJ software, NIH, Bethesda, MD, USA) is used to compute hue histograms on average EUS elastography images, while the hue histograms values for each patient (0 to 255 values) are further used to classify the patients with benign and malignant lesions.

Ultrasound elastography will be performed during an usual EUS examination (7.5 MHz frequency), with two movies of 10 seconds recorded on the embedded HDD in order to minimize variability and to increase repeatability of acquisition. A two panel image with the usual conventional gray-scale B-mode EUS image on the right side and with the elastography image on the left side will be used. The region of interest will be preferably larger than the focal mass, in order to include the surrounding structures. In order to minimize the human bias, all the post-processing and computer analysis of digital movies will be performed within the IT Center in Craiova, with all programmers and statisticians being blinded to the clinical, pathological and imaging data, with the exception of the average hue histogram values calculated from a second region of interest manually traced around the focal mass.

The study design is prospective, blinded and multi-center, comparing endoscopic ultrasound elastography (EUS-EG) results for the detection and characterization of focal pancreatic masses by using artificial intelligence techniques, in comparison with the gold standard represented by pathology. The study will be performed with the approval of the institutional board review of each center.

Conditions

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Pancreatic Adenocarcinoma Chronic Pancreatitis

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Pancreatic adenocarcinoma

Patients diagnosed with solid pancreatic adenocarcinoma masses, with cytological / histological confirmation

No interventions assigned to this group

Chronic pancreatitis

Patients diagnosed with solid pancreatic tumor masses with all the criteria fulfilled to exclude pancreatic cancer

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Patients diagnosed with solid pancreatic tumor masses, with cytological / histological confirmation
* Age 18 to 80 years old, men or women
* Signed informed consent for EUS with elastography and FNA biopsy

Exclusion Criteria

* Prior surgical treatment with curative intent or chemo-radiotherapy
* Patients diagnosed with mucin producing tumors, pancreatic cystic tumors, etc.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Gentofte, Copenhagen

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role collaborator

Institut Paoli-Calmettes

OTHER

Sponsor Role collaborator

San Raffaele University Hospital, Italy

OTHER

Sponsor Role collaborator

UCL (Univ), Brussels, Belgium

UNKNOWN

Sponsor Role collaborator

Glasgow Royal Infirmary

OTHER

Sponsor Role collaborator

Caritas-Krankenhaus Bad Mergentheim

OTHER

Sponsor Role collaborator

University of Bergen

OTHER

Sponsor Role collaborator

University of Witten/Herdecke

OTHER

Sponsor Role collaborator

Newcastle-upon-Tyne Hospitals NHS Trust

OTHER

Sponsor Role collaborator

University of Medicine and Pharmacy Craiova

OTHER

Sponsor Role lead

Responsible Party

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University of Medicine and Pharmacy Craiova, Romania

Principal Investigators

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Adrian Saftoiu, Professor

Role: STUDY_DIRECTOR

University of Medicine and Pharmacy Craiova, Romania

Locations

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Erasme University

Brussels, , Belgium

Site Status

Universite Chatolique Louvain

Brussels, , Belgium

Site Status

Gentofte University Hospital

Copenhagen, , Denmark

Site Status

University Hospital

Odense, , Denmark

Site Status

Institute Paoli Calmettes

Marseille, , France

Site Status

Caritas-Krankenhaus

Bad Mergentheim, , Germany

Site Status

St. Josef Hospital

Bochum, , Germany

Site Status

SRH Klinik

Gera, , Germany

Site Status

University Clinic Mainz

Mainz, , Germany

Site Status

Dr.Horst-Schmidt-Klinik

Wiesbaden, , Germany

Site Status

HELIOS Klinikum Wuppertal, University of Witten/Herdecke

Wuppertal, , Germany

Site Status

Hospital San Raffaele

Milan, , Italy

Site Status

Erasme Medisch Centrum

Rotterdam, , Netherlands

Site Status

University of Haukeland

Bergen, , Norway

Site Status

University of Medicine and Pharmacy Craiova

Craiova, , Romania

Site Status

University Hospital Santiago

Santiago, , Spain

Site Status

Glasgow Royal Infirmary

Glasgow, , United Kingdom

Site Status

Newcastle Upon Tyne Hospitals

Newcastle, , United Kingdom

Site Status

Countries

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Belgium Denmark France Germany Italy Netherlands Norway Romania Spain United Kingdom

References

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Frey H. [Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity]. Radiologe. 2003 Oct;43(10):850-5. doi: 10.1007/s00117-003-0943-2. German.

Reference Type BACKGROUND
PMID: 14605701 (View on PubMed)

Ophir J, Alam SK, Garra B, Kallel F, Konofagou E, Krouskop T, Varghese T. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H. 1999;213(3):203-33. doi: 10.1243/0954411991534933.

Reference Type BACKGROUND
PMID: 10420776 (View on PubMed)

Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, Yamakawa M, Matsumura T. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006 May;239(2):341-50. doi: 10.1148/radiol.2391041676. Epub 2006 Feb 16.

Reference Type BACKGROUND
PMID: 16484352 (View on PubMed)

Miyanaga N, Akaza H, Yamakawa M, Oikawa T, Sekido N, Hinotsu S, Kawai K, Shimazui T, Shiina T. Tissue elasticity imaging for diagnosis of prostate cancer: a preliminary report. Int J Urol. 2006 Dec;13(12):1514-8. doi: 10.1111/j.1442-2042.2006.01612.x.

Reference Type BACKGROUND
PMID: 17118027 (View on PubMed)

Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007 Aug;92(8):2917-22. doi: 10.1210/jc.2007-0641. Epub 2007 May 29.

Reference Type BACKGROUND
PMID: 17535993 (View on PubMed)

Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc. 2007 Jun;65(7):971-8. doi: 10.1016/j.gie.2006.12.057.

Reference Type BACKGROUND
PMID: 17531630 (View on PubMed)

Saftoiu A, Vilmann P, Ciurea T, Popescu GL, Iordache A, Hassan H, Gorunescu F, Iordache S. Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes. Gastrointest Endosc. 2007 Aug;66(2):291-300. doi: 10.1016/j.gie.2006.12.039.

Reference Type BACKGROUND
PMID: 17643702 (View on PubMed)

Saftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, Iglesias-Garcia J, Arcidiacono P, Will U, Giovannini M, Dietrich CF, Havre R, Gheorghe C, McKay C, Gheonea DI, Ciurea T; European EUS Elastography Multicentric Study Group. Efficacy of an artificial neural network-based approach to endoscopic ultrasound elastography in diagnosis of focal pancreatic masses. Clin Gastroenterol Hepatol. 2012 Jan;10(1):84-90.e1. doi: 10.1016/j.cgh.2011.09.014. Epub 2011 Oct 1.

Reference Type DERIVED
PMID: 21963957 (View on PubMed)

Saftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, Iglesias-Garcia J, Arcidiacono P, Will U, Giovannini M, Dietrich C, Havre R, Gheorghe C, McKay C, Gheonea DI, Ciurea T; European EUS Elastography Multicentric Study Group. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011 Jul;43(7):596-603. doi: 10.1055/s-0030-1256314. Epub 2011 Mar 24.

Reference Type DERIVED
PMID: 21437851 (View on PubMed)

Related Links

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Other Identifiers

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EUS-EG-UMFCV-RO

Identifier Type: -

Identifier Source: secondary_id

EUS-EG001

Identifier Type: -

Identifier Source: org_study_id

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