Okasha, H., S. Elkholy, R. El-Sayed, M. - N. Wifi, M. El-Nady, W. El-Nabawi, W. A. El-Dayem, M. I. Radwan, A. L. I. FARAG, Y. El-sherif, et al., "Real time endoscopic ultrasound elastography and strain ratio in the diagnosis of solid pancreatic lesions.", World journal of gastroenterology, vol. 23, issue 32, pp. 5962-5968, 2017. Abstract

AIM: To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).

METHODS: A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.

RESULTS: SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.

CONCLUSION: Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.

Elkholy, S., K. Essam, and M. El-Sherbiny, "Pulmonary embolism as an early sequel of per oral endoscopic myotomy (POEM) for treatment of achalasia : to anticoagulate or not?", Acta gastro-enterologica Belgica, vol. 81, issue 4, pp. 543-544, 2018.
Okasha, H., S. Elkholy, M. Sayed, M. El-Sherbiny, R. El-Hussieny, E. El-Gemeie, W. Al-Nabawy, M. S. Mohamed, and Y. Elsherif, "Ultrasound, endoscopic ultrasound elastography, and the strain ratio in differentiating benign from malignant lymph nodes.", Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology, vol. 19, issue 1, pp. 7-15, 2018. Abstract

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound elastography (EUS-elastography), or sono-elastography, has emerged in the past 2 decades as a qualitative method of estimating tissue stiffness. Strain elastography allows for semi-quantitative measurements of the average elasticity of a lesion, and previous studies have proposed the strain ratio (SR) for overcoming the limitations of the elasticity score. The main objective of this study is to assess the specificity, sensitivity and predictive values of the SR measured by EUS-elastography in differentiating benign from malignant lymph nodes (LNs). This study also aims to find significant ultrasonographic features other than the SR which could help in predicting LN malignancy.

PATIENTS AND METHODS: This prospective study included 126 Egyptian patients with lymphadenopathy. US and EUS-elastography and the SR were assessed, in addition to detailed sonographic features, including size, longest diameter, shortest diameter, ratio of shortest/longest diameter, echotexture (echogenic or echo-poor) and hilum (lost or preserved).

RESULTS: The SR cut-off value of 4.61 showed a sensitivity and specificity of 89.8% and 83.3%, respectively. This parameter had high positive and negative predictive values of 82.5% and 90.2%, respectively, for predicting malignant LNs. Univariate regression analysis showed that echogenicity, hilum preservation, elastography, the shortest dimension, the ratio of the shortest/longest dimension, ultrasound diagnosis and SR could be potential predictors of the final lymph node diagnosis. Sono-diagnosis depending on echogenicity, the shortest/longest diameter ratio and a preserved hilum in combination was the only predictive parameter in multivariate regression analysis.

CONCLUSION: EUS-elastography and the SR could be excellent prognostic indices in differentiating benign from malignant lymph nodes if combined with other US features.

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