Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions.

Background: Endoscopic ultrasonography (EUS) has become an established method in diagnostic and therapeutic procedures in gastroenterology; however, it has recently gained a growing role in hepatology.

Aim: To evaluate the role of EUS features, strain elastography (SE), and EUS-tissue acquisition in diagnosing hepatic focal lesions (HFLs) that could affect further management.

Methods: This cross-sectional study included 215 patients with pancreatic, biliary, or gastrointestinal malignancies referred for EUS examination. HFLs were identified in 43 patients (20%), and EUS-guided tissue acquisition was performed from these lesions.

Results: EUS features were highly sensitive (100%) but much less specific (57%) in diagnosing HFLs; the overall accuracy was 94%. Real-time elastography was also very sensitive (97%) but less specific (67%) in diagnosing HFLs; however, the overall accuracy was 92%. EUS tissue acquisition was extremely sensitive (100%) and specific (100%), with a 100% overall diagnostic accuracy.

Conclusion: The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs. EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.