Gf ue260 al5 gf uct260

US and EUS were performed by one physician with 35 years of clinical experience in conducting US examinations and 20 years of experience in EUS. First, the pancreas was carefully investigated using a convex US transducer with a frequency of 3.5 MHz (Aplio500; Canon Medical Systems, Otawara, Japan). For detailed evaluation of the pancreas, the US included transverse and oblique scan planes at different levels. The spleen was often used as a sonic window to visualize the tail of the pancreas. EUS was subsequently performed using a radial/linear echoendoscope (GF-UE260-AL5/GF-UCT260; Olympus Corp., Tokyo, Japan) under moderate sedation. EUS was conducted in various planes, with both transgastric and tranduodenal access to scan the whole pancreas, detect the PCL, and characterize its morphology. Imaging analysis was performed using INFINITT PACS 3.0.11.3 BN104 (INFINITT Healthcare Co., Seoul, Korea).

EUS (GF-UE260-AL5, GF-UCT260; Olympus, Tokyo, Japan) with ultrasound observation systems (ALOKA ProSound SSD α-10; Aloka Co. Ltd, Tokyo, Japan) was performed under sedation. Fundamental B-mode EUS was initially performed. After using the fundamental B-mode, CH-EUS was performed for the differential diagnosis of the pancreatic lesion. CH-EUS was performed with the extended pure harmonic detection method for which the mechanical index was set at 0.35. Sonazoid (Daiichi Sankyo Co. Ltd., Tokyo, Japan) was used to perform CH-EUS. It is a second-generation ultrasonography contrast agent composed of perfluorobuthane microbubbles whose median diameter was 2–3 μm [8 (link)]. Vascular patterns were continuously assessed in real-time after infusion of contrast agent. Two endosonographers evaluated EUS images When there was a conflicting assessment between the two reviewers, they re-evaluated the data together until an agreement was reached. First, they evaluated whether a pancreatic nodule was present or not. Second, when a nodule was present, they evaluated whether the nodule was hypovascular compared to the surrounding tissue. Pancreatic cancer was defined as a hypovascular nodule on CH-EUS.