P3466 - How Good is EUS Elastography for Discriminating Malignant From Benign Solid Pancreatic Masses? A Systematic Review and Meta-Analysis

Renato Beas, MD¹, Eleazar Enrique. Montalvan-Sanchez, MD², Dalton A.. Norwood, MD³, Elit Quingalahua, MD⁴, Ana Vilela, MD⁵, Janice Lester, ⁶, Jean M. Chalhoub, MD⁶, Jorge Machicado, MD, MPH^7
1Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO; ²Yale Digestive Diseases, New Haven, CT; ³UAB Minority Health & Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ⁴Central Michigan University, Saginaw, MI; ⁵Eastern Virginia Medical School, Norfolk, VA; ⁶Staten Island University Hospital, Northwell Health, Staten Island, NY; ⁷University of Michigan, Ann Arbor, MI

Introduction: EUS elastography has shown promising results in the differential diagnosis of benign and malignant pancreatic lesions. We aimed to systematically review and conduct a meta-analysis to evaluate the diagnostic performance of EUS elastography for discriminating malignant from benign solid pancreatic masses.

Methods: A medical librarian conducted a comprehensive literature search of MEDLINE, EMBASE, and Cochrane Central from inception to September 2023. We included all published studies of adult participants who underwent EUS elastography for diagnosis of solid pancreatic masses and that provided results of cytology or histopathology obtained via EUS, surgical resection, or other method as reference standard. Two reviewers independently screened and selected the studies, extracted data, and evaluated the risk of bias. Statistical analyses were performed using Stata 18, utilizing the metandi and midas packages. A bivariate meta-analysis of sensitivity and specificity was performed, accounting for the correlation between these two measures.

Results: Among 519 articles identified, 66 studies were identified for full text review and 35 studies were eligible for inclusion (n= 4,209 patients). The fitted model for EUS elastography in diagnosing pancreatic masses revealed a high sensitivity and moderate specificity. The pooled sensitivity was estimated at 0.96 (95% CI: 0.93-0.98) and pooled specificity was estimated at 0.74 (95% CI: 0.65-0.81). Additionally, moderate to substantial heterogeneity among the included studies was found, particularly for specificity, indicating variability in the diagnostic performance across different settings and populations. These results are depicted in Figure 1A, which shows the Forest Plot for the sensitivity and specificity for each study. Also, a summary point on the HSROC (Hierarchical Summary Receiver Operating Characteristic) plot is shown in Figure 1B. The summary of accuracy statistics can be seen in Table 1.

Discussion: EUS elastography demonstrates excellent sensitivity and moderate specificity in differentiating malignant from benign solid pancreatic masses. The high sensitivity of EUS elastography makes it a helpful tool for minimizing false negative results, which could help excluding malignancy when a cytologic or histologic interpretation is not diagnostic of malignancy. Given its moderate specificity and potential false positive results, a malignant appearance of malignancy on elastography will usually require cytologic or histologic confirmation.



Disclosures:


Renato Beas, MD¹, Eleazar Enrique. Montalvan-Sanchez, MD², Dalton A.. Norwood, MD³, Elit Quingalahua, MD⁴, Ana Vilela, MD⁵, Janice Lester, ⁶, Jean M. Chalhoub, MD⁶, Jorge Machicado, MD, MPH⁷. P3466 - How Good is EUS Elastography for Discriminating Malignant From Benign Solid Pancreatic Masses? A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.