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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13212-13224
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13212
Endoscopic ultrasound elastography: Current status and future perspectives
Xin-Wu Cui, Jian-Min Chang, Quan-Cheng Kan, Liliana Chiorean, Andre Ignee, Christoph F Dietrich
Xin-Wu Cui, Jian-Min Chang, Christoph F Dietrich, Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Xin-Wu Cui, Liliana Chiorean, Andre Ignee, Christoph F Dietrich, Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, 97980 Würzburg, Germany
Quan-Cheng Kan, Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Liliana Chiorean, Département d’imagerie médicale, Clinique des Cévennes, 07100 Annonay, France
Author contributions: Dietrich CF established the design and conception of the paper and provided the figures; Cui XW, Chang JM, Kan QC, Chiorean L, Ignee A and Dietrich CF analyzed the literature data; Dietrich CF provided the first draft of the manuscript, which was discussed and revised critically for intellectual content by Cui XW, Chang JM, Kan QC, Chiorean L, Ignee A and Dietrich CF; all authors discussed the statement and conclusions and approved the final version to be published.
Conflict-of-interest statement: We declare that we do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christoph F Dietrich, Professor, Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road No. 1, Zhengzhou 450052, Henan Province, China. christoph.dietrich@ckbm.de
Telephone: +86-371-66913150 Fax: +86-371-66913150
Received: March 1, 2015
Peer-review started: March 2, 2015
First decision: July 13, 2015
Revised: August 4, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 21, 2015
Processing time: 289 Days and 12.2 Hours
Abstract

Elastography is a new ultrasound modality that provides images and measurements related to tissue stiffness. Endoscopic ultrasound (EUS) has played an important role in the diagnosis and management of numerous abdominal and mediastinal diseases. Elastography by means of EUS examination can assess the elasticity of tumors in the proximity of the digestive tract that are hard to reach with conventional transcutaneous ultrasound probes, such as pancreatic masses and mediastinal or abdominal lymph nodes, thus improving the diagnostic yield of the procedure. Results from previous studies have promised benefits for EUS elastography in the differential diagnosis of lymph nodes, as well as for assessing masses with pancreatic or gastrointestinal (GI) tract locations. It is important to mention that EUS elastography is not considered a modality that can replace biopsy. However, it may be a useful adjunct, improving the accuracy of EUS-fine needle aspiration biopsy (EUS-FNAB) by selecting the most suspicious area to be targeted. Even more, it may be useful for guiding further clinical management when EUS-FNAB is negative or inconclusive. In the present paper we will discuss the current knowledge of EUS elastography, including the technical aspects, along with its applications in the differential diagnosis between benign and malignant solid pancreatic masses and lymph nodes, as well as its aid in the differentiation between normal pancreatic tissues and chronic pancreatitis. Moreover, the emergent indication and future perspectives are summarized, such as the benefit of EUS elastography in EUS-guided fine needle aspiration biopsy, and its uses for characterization of lesions in liver, biliary tract, adrenal glands and GI tract.

Keywords: Elastography; Endoscopic ultrasound; Characterization; Pancreas; Lymph nodes

Core tip: Endoscopic ultrasound (EUS) has played an important role in the diagnosis and management of numerous abdominal and mediastinal diseases. In the present paper, we discuss the current knowledge of EUS elastography, including the technical aspects, its applications in the differentiation between benign and malignant solid pancreatic masses and lymph nodes, and differentiation between normal pancreatic tissues and chronic pancreatitis. Moreover, the emergent indication and future perspectives are also summarized, such as the benefit of EUS elastography in EUS-guided fine needle aspiration biopsy, and its use for characterization of lesions in liver, biliary tract, adrenal glands and gastrointestinal tract.