Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer

BackgroundEUS elastography is a newly developed imaging procedure that characterizes the differences of hardness and strain between diseased and normal tissue.ObjectiveTo assess the accuracy of real-time EUS elastography in pancreatic lesions.DesignCross-sectional feasibility study.PatientsThe study group included, in total, 68 patients with normal pancreas (N = 22), chronic pancreatitis (N = 11), pancreatic adenocarcinoma (N = 32), and pancreatic neuroendocrine tumors (N = 3). A subgroup analysis of 43 cases with focal pancreatic masses was also performed.InterventionsA postprocessing software analysis was used to examine the EUS elastography movies by calculating hue histograms of each individual image, data that were further subjected to an extended neural network analysis to differentiate benign from malignant patterns.Main Outcome MeasurementsTo differentiate normal pancreas, chronic pancreatitis, pancreatic cancer, and neuroendocrine tumors.ResultsBased on a cutoff of 175 for the mean hue histogram values recorded on the region of interest, the sensitivity, specificity, and accuracy of differentiation of benign and malignant masses were 91.4%, 87.9%, and 89.7%, respectively. The positive and negative predictive values were 88.9% and 90.6%, respectively. Multilayer perceptron neural networks with both one and two hidden layers of neurons (3-layer perceptron and 4-layer perceptron) were trained to learn how to classify cases as benign or malignant, and yielded an excellent testing performance of 95% on average, together with a high training performance that equaled 97% on average.LimitationA lack of the surgical standard in all cases.ConclusionsEUS elastography is a promising method that allows characterization and differentiation of normal pancreas, chronic pancreatitis, and pancreatic cancer. The currently developed methodology, based on artificial neural network processing of EUS elastography digitalized movies, enabled an optimal prediction of the types of pancreatic lesions. Future multicentric, randomized studies with adequate power will have to establish the clinical impact of this procedure for the differential diagnosis of focal pancreatic masses.