Diagnostic Value of Combined Endoscopic Ultrasound Elastography and Contrast-Enhanced Ultrasound in Solid Pancreatic Lesions

Diagnostic Value of Combined Endoscopic Ultrasound Elastography and Contrast-Enhanced Ultrasound in Solid Pancreatic Lesions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Value of Combined Endoscopic Ultrasound Elastography and Contrast-Enhanced Ultrasound in Solid Pancreatic Lesions Caixia Zhao, Rongxing Shi, Tingting He, Qin Lu, Zhe Liu, Peng Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9395390/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective: To evaluate the diagnostic efficacy of endoscopic ultrasound elastography (EUS-E), contrast-enhanced endoscopic ultrasound (CE-EUS), and their combined application in distinguishing benign from malignant solid pancreatic lesions (SPLs), thereby providing evidence for precise clinical diagnosis and individualised treatment. Methods: . This study is a single-center, prospective study. Patients who were diagnosed with pancreatic lesions and underwent EUS-E and CE-EUS examinations at the Endoscopy Center of the Guiyang Medical University Affiliated Tumor Hospital from September 2022 to December 2025 were included. Patients were divided into malignant and non-malignant groups based on the results of the pathological examination, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), or at least six months of follow-up. The differences in clinical characteristics and imaging indicators between the two groups were compared. Results: This study included 203 patients with solid pancreatic lesions (176 malignant, 27 non-malignant). The combined diagnostic approach of EUS-E and CE-EUS (elasticity score ≥3 points and CE-EUS showing low/high enhancement) demonstrated excellent efficacy: sensitivity 0.90, specificity 0.22, accuracy 0.81,with an AUC of 0.58 (95% CI: 0.445–0.72), indicating that the combined diagnostic strategy significantly enhances the ability to distinguish between benign and malignant pancreatic lesions. Conclusions: EUS-E demonstrates high sensitivity, aiding in the early detection of malignant lesions, but its low specificity carries a risk of misdiagnosis.CE-EUS exhibits strong specificity and excels in identifying perfusion abnormalities, though it may overlook certain hypoperfused lesions. The combined application of EUS-E and CE-EUS markedly improves diagnostic balance, achieving high sensitivity and specificity with an AUC of 0.58, surpassing either modality alone. pancreatic solid lesions endoscopic ultrasound elastography contrast-enhanced endoscopic ultrasound combined diagnosis Figures Figure 1 Figure 2 Figure 3 Introduction Solid pancreatic lesions (SPLs) primarily originate from the exocrine and endocrine tissues of the pancreas, encompassing pancreatic ductal adenocarcinoma (PDAC), neuroendocrine tumours, solid pseudopapillary tumours, pancreatic blastoma, pancreatic lymphoma, and metastatic pancreatic tumours, among others [1] .Due to its unique anatomical location and histological characteristics, coupled with relative insensitivity to pain stimuli, pancreatic diseases often present insidiously in their early stages with non-specific clinical manifestations. This contributes to the highly invasive nature and extremely poor prognosis of pancreatic cancer, making it one of the leading causes of cancer-related mortality globally [2–4] .Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is frequently employed as the primary diagnostic modality for pancreatic masses in clinical practice [5] . However, EUS-FNA carries risks of multiple complications, including acute pancreatitis, haemorrhage, infection, and needle-track implantation metastasis [6–8] .Moreover, its diagnostic performance diminishes in the context of chronic pancreatitis [9] . With advances in endoscopic technology, novel EUS-based imaging diagnostic methods have emerged, giving rise to two new approaches: Endoscopic ultrasound elastography (EUS-E) and contrast-enhanced endoscopic ultrasound (CE-EUS). Both enable non-invasive differentiation of pancreatic lesions, providing more precise imaging support for clinical decision-making. EUS-E quantifies tissue stiffness variations through mechanical stimulation combined with ultrasonic signal analysis, offering crucial supplementary information for distinguishing benign from malignant lesions in the digestive tract and adjacent organs. Based on tissue stiffness and elasticity characteristics, Giovannini et al. proposed a five-point elastography scoring system [10] , where scores ≥3 suggest malignant lesions, while scores <2 typically indicate benign lesions [11,12] .Semi-quantitative analysis employs the strain ratio (SR), calculated as SR_(lesion)/SR_(peripheral tissue). Studies indicate that benign pancreatic lesions exhibit significantly lower SR values than malignant lesions, with median SR values of 7.33 for benign versus 20.07 for malignant lesions [12] .CE-EUS employs intravenous injection of second-generation microbubble contrast agents (e.g., Sonazoid or SonoVue). These microbubbles distribute intravascularly and enhance blood flow signals, thereby visualising target organ vascular distribution and perfusion patterns [13,14] .The combined application of EUS-E and CE-EUS enables simultaneous assessment of lesion tissue stiffness and microvascular perfusion characteristics, conducting a more comprehensive differential diagnosis of SPLs. While this combined approach demonstrates potential in diagnosing pancreatic solid lesions, its application remains challenging. Due to its operational complexity, high cost, and insufficient training, this technique is currently limited to a small number of large hospitals in China. Consequently, related research remains scarce, predominantly consisting of small-sample retrospective analyses, with evidence quality and generalisability requiring improvement [15] .This study evaluates the performance of elastic imaging scores, SR, and contrast-enhanced imaging in diagnosing SPLs in patients who were treated at our hospital. The aim is to improve the accuracy of the initial diagnosis of patients with pancreatic solid lesions, provide reliable information for subsequent treatment plans, reduce unnecessary examinations, shorten the diagnostic and treatment cycle, and improve patient management and prognosis. Materials and Methods Study Population From September 2022 to December 2025, patients who were diagnosed with pancreatic masses through abdominal ultrasound, CT, MRI, or EUS examinations, but whose diagnoses were not confirmed, were referred to the Endoscopy Center at the Guizhou University of Traditional Chinese Medicine Affiliated Hospital for further evaluation and successful CE-EUS and EUS-E examinations.Patient demographics collected included: admission number, telephone number, gender, age, body mass index (BMI), smoking history, diabetes history, and tumour history. Endoscopic ultrasound data comprised: pancreatic mass location, size, elastography images with scoring, shear rate (SR), and contrast enhancement patterns.This prospective observational study was approved by the Ethics Committee of Guizhou Medical University Cancer Hospital (Ethics Approval Number: SL-202104092). nclusion Criteria (1) Patients with pancreatic space-occupying lesions identified by conventional imaging studies where the nature of the lesion remained unclear; (2) Patients without contraindications for EUS and who signed the relevant informed consent form; (3) EUS findings indicating solid or predominantly solid-cystic lesions;(4) Diagnosis of pancreatic lesions confirmed by one of the following methods: pathological examination following surgical resection, EUS-guided fine-needle aspiration (EUS-FNA), or comprehensive clinical diagnosis (including imaging studies, laboratory tests, and clinical characteristics). Exclusion Criteria (1) Patients with EUS findings indicating entirely or predominantly cystic pancreatic lesions; (2) Incomplete or missing data; (3) Patients with severe cardiopulmonary or neurological conditions rendering them intolerant to EUS or intravenous anaesthesia;(4) Patients with acute oropharyngeal or oesophageal injury posing a high risk of endoscopic perforation; (5) Patients with severe psychiatric disorders rendering them non-cooperative; (6) Pregnant or lactating women; (7) Patients with contrast medium allergy. Methods Equipment and Reagents: Ultrasound endoscope: GF-UCT260-AL5 (Olympus, Tokyo, Japan). Ultrasound endoscope control unit: EU-ME2 PREMIER PLUS (Olympus, Tokyo, Japan). Ultrasound contrast agent: SonoVue (sulphur hexafluoride microbubbles, Bracco, Italy). Each vial contained 25 mg lyophilised powder dissolved in 5 ml saline solution, shaken to form a suspension. 2.4 ml was rapidly injected via the antecubital vein, followed by 5 ml saline solution for flushing. Endoscopic Ultrasound Procedure Pre-examination Preparation: Patient preparation: Fasting for 6–8 hours and no fluid intake for 4 hours prior to examination; informed consent obtained. Sedation and analgesia: Pharyngeal local anaesthesia (lidocaine gel), intravenous sedation (midazolam), with continuous ECG monitoring throughout. Procedure: Conventional EUS: Enter the gastric cavity transorally, adjust position to localise the pancreas. Employ grey-scale ultrasound and colour Doppler to evaluate lesion morphology and blood flow distribution. Elastography Mode Switch: Activate elastography function, select region of interest (ROI) covering the lesion and surrounding normal pancreatic tissue. Hardness Analysis: Image Interpretation: Blue: High tissue stiffness; Green/Red: Softer tissue.Semi-quantitative parameters: Elastic strain ratio; Dynamic compression: Apply gentle endoscopic pressure to stabilise elastic signals (avoid excessive pressure causing error). Collect and analyse recorded EUS elastography images and SR values, then perform elastography scoring. Ultrasound Contrast Enhancement: Administer Sonovue intravenously, immediately initiating contrast mode to synchronously record arterial phase (10–30 seconds) and venous phase (30–120 seconds). Assess enhancement patterns of pancreatic masses relative to surrounding parenchyma (no enhancement, low enhancement, equal enhancement, high enhancement). Interpretation of Results EUS Elastography (EUS-E): Employ a five-point scoring system: Score 1 (entirely green), Score 2 (blue-green mixed with predominant green), Score 3 (predominantly blue with peripheral green), Score 4 (almost entirely blue with minor mottling), Score 5 (predominantly blue with coarse red/green streaks and peripheral blue); a score ≥3 indicates malignancy. Contrast-enhanced EUS (CE-EUS): Following the European Federation of Ultrasound in Medicine and Biology (EFUMAB) criteria [16] , contrast enhancement is assessed in arterial and venous phases. The arterial phase is graded as high/equal/low/no enhancement based on echogenicity intensity; the venous phase evaluates diffuse enhancement (echogenicity ≥ surrounding tissue). Low or high arterial enhancement is interpreted as malignant. Combined Diagnosis: EUS-E score ≥3 points with CE-EUS showing low/high enhancement defined as combined positive; all others as combined negative. Images were independently interpreted by two physicians, with discrepancies resolved through discussion or third-party adjudication. Final Diagnosis (Gold Standard): (1) Surgical pathology/immunohistochemistry. (2) Definitive evidence of malignancy based on histopathology from EUS-FNA; cases inconclusive for diagnosis shall be assessed comprehensively using clinical and imaging/tumour marker data, followed by ≥6 months of follow-up: progression/metastasis indicates malignancy; stable disease without progression indicates non-malignancy. Statistical Methods Data analysis was performed using SPSS 26.0 and R 4.3.0 statistical software. Count data were expressed as case numbers or percentages, with intergroup comparisons conducted using χ² test or Fisher's exact test. Continuous variables meeting normal distribution were presented as mean ± standard deviation, with intergroup comparisons using independent samples t-tests; non-normally distributed continuous variables were presented as median (interquartile range), with intergroup comparisons using Fisher's exact test or Mann-Whitney U test. P < 0.05 indicated statistically significant differences. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for EUS-E, CE-EUS, and their combined diagnosis, using the final diagnostic outcome as the gold standard. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) with its 95% confidence interval was calculated. Logistic regression was employed to identify independent factors influencing pancreatic cancer diagnosis. Univariate logistic regression initially screened potential associated variables, followed by a bidirectional stepwise approach to establish a multivariate model and identify independent predictors. Results General characteristics of the study subjects This study included 203 subjects, all of whom underwent EUS-E and CE-EUS examinations. Among these, 188 patients underwent EUS-FNA with histopathological results obtained; 15 patients underwent surgical resection with postoperative pathological results obtained.Pathological diagnosis confirmed pancreatic cancer in 158 patients, metastatic cancer in 6 (originating from rectum, breast, ovary, and bile duct respectively), while the remaining 24 patients had negative or indeterminate pathological results. Following at least 6 months of follow-up, the final diagnosis was confirmed:Among these, 12 cases were malignant: 7 pancreatic neuroendocrine tumours, 1 pancreatic neuroendocrine carcinoma, 1 pancreatic solid pseudopapillary tumour, 1 high-grade ductal intraepithelial neoplasia, 1 pancreatic adenocarcinoma, and 1 pancreatic mucinous epithelial tumour.27 non-malignant cases comprised 20 pancreatic inflammatory masses, 1 pancreatic tuberculosis, 3 benign pancreatic epithelial tumours, 1 pancreatic abscess, and 2 pancreatic serous cystadenomas. See Table 1 for details. Among the 203 patients, 176 (86.70%) were ultimately diagnosed with malignant lesions, while non-malignant lesions accounted for 13.30%. Among malignant patients, BMI distribution showed: <18.50 kg/m² accounted for 16.48%; 18.50–25.00 kg/m² constituted 67.05%; ≥25 kg/m² comprised 16.48%.Among patients with a final clinical diagnosis of non-malignant lesions, BMI distribution was as follows: <18.50 kg/m² (18.52%), 18.50–25.00 kg/m² (70.37%), ≥25 kg/m² (11.11%).The difference in gender distribution between the two groups was statistically significant (P=0.0497). No statistically significant differences were observed between the two groups in age distribution, presence of diabetes, history of tumours, or smoking status (all P>0.05). See Table 1 for details. Table 1 Characteristics of the Patients’ Clinical Data and Distribution of Diagnoses Variable Non-malignant (n=27) Malignant (n=176) Statistic P Age (years) 57.59 ± 12.17 60.88 ± 10.08 T = -1.5339 0.1266 BMI (Kg/m²) T = 1.1966 0.2329 ＜18.50 5 (18.52%) 29 (16.48%) 18.50-25.00 19 (70.37%) 118 (67.05%) ≥25 3 (11.11%) 29 (16.48%) Gender χ² = 3.8524 0.0497* Female 6 (22.22%) 74 (42.05%) Male 21 (77.78%) 102 (57.95%) Diabetes - 1 No 22 (81.48%) 144 (81.82%) Yes 5 (18.52%) 32 (18.18%) Tumor History - 0.6637 No 25 (92.59%) 166 (94.32%) Yes 2 (7.41%) 10 (5.68%) Smoking History χ² = 0.7540 0.3852 No 12 (44.44%) 94 (53.41%) Yes 15 (55.56%) 82 (46.59%) Final Diagnosis Count Inflammatory Mass 20 (9.85%) Pancreatic Tuberculosis 1 (0.49%) Pancreatic Abscess 1 (0.49%) Benign Epithelial Tumor 3 (1.85%) Serous Cystadenoma 2 (0.98%) Pancreatic Cancer 158 (77.83%) Pancreatic Neuroendocrine Tumor 7 (3.45%) Solid Pseudopapillary Tumor 1 (0.49%) High-grade Intraepithelial Neoplasia 1 (0.49%) Metastatic Carcinoma 6 (2.96%) Pancreatic Neuroendocrine Carcinoma 1 (0.49%) Pancreatic Adenosquamous Carcinoma 1 (0.49%) Mucinous Epithelial Tumor 1 (0.49%） Note: T : T-test, χ²: Chi-square test, -: Fisher's exact test, *P <0.05 indicates statistically significant difference. Characteristics of endoscopic ultrasound data in study subjects Distribution of Endoscopic Ultrasound Elastography Scores in Study Subjects Ultrasound endoscopic elastography examinations were performed on patients (as shown in Figure 1). Distribution of elastography scores among 203 patients As shown in Table 2, the cases comprised 158 pancreatic carcinomas, 7 neuroendocrine tumours, 1 pancreatic solid pseudopapillary neoplasm, 1 high-grade ductal intraepithelial neoplasia, 6 metastatic carcinomas,1 case of pancreatic neuroendocrine carcinoma, 1 case of pancreatic tuberculosis, 3 cases of benign pancreatic epithelial tumours, 2 cases of pancreatic serous cystadenoma, 1 case of pancreatic mucinous epithelial tumour, 1 case of pancreatic cyst, and 1 case of pancreatic adenocarcinoma all had Elastography scores ≥3.Among 20 patients with pancreatic inflammatory masses, 2 scored 2 points, 2 scored 3 points, 7 scored 4 points, and 9 scored 5 points. See Table 2 for details. Table 2 Distribution of Elastography Scores for Solid Pancreatic Occupancies of Different Pathologic Types Pathological Type Total Elastography Score 1 2 3 4 5 Pancreatic Cancer 158 37 121 Pancreatic Neuroendocrine Tumor 7 3 4 Solid Pseudopapillary Tumor 1 1 High-grade Intraepithelial Neoplasia 1 1 Metastatic Carcinoma 6 2 4 Pancreatic Neuroendocrine Carcinoma 1 1 Mucinous Epithelial Tumor 1 1 Pancreatic Abscess 1 1 Pancreatic Adenosquamous Carcinoma 1 1 Inflammatory Mass 20 2 2 7 9 Pancreatic Tuberculosis 1 1 Benign Epithelial Tumor 3 1 2 Serous Cystadenoma 2 2 Distribution of Contrast-Enhanced Patterns in Study Subjects Contrast-enhanced endoscopic ultrasound assessment of pancreatic masses (as shown in Figure 2). The contrast enhancement patterns of 203 pancreatic solid lesions with different pathological types are presented in Table 3.Among the 176 patients with a final clinical diagnosis of malignant lesions, 16 exhibited no enhancement, 141 showed low enhancement, 6 demonstrated isoechoic enhancement, and 13 displayed high enhancement. Among the 27 non-malignant lesions, 3 showed no enhancement, 20 exhibited low enhancement, 1 demonstrated isoechoic enhancement, and 3 displayed high enhancement. Table 3 Distribution of Contrast-Enhancement Patterns in Solid Pancreatic Lesions of Different Pathological Types Pathological Type Total Contrast-Enhancement Pattern Non- Hypo- Iso- Hyper- Pancreatic Cancer 158 14 132 5 7 Pancreatic Neuroendocrine Tumor 7 3 1 3 Solid Pseudopapillary Tumor 1 1 High-grade Intraepithelial Neoplasia 1 1 Metastatic Carcinoma 6 4 2 Pancreatic Neuroendocrine Carcinoma 1 1 Mucinous Epithelial Tumor 1 1 Pancreatic Abscess 1 1 Pancreatic Adenosquamous Carcinoma 1 1 Inflammatory Mass 20 2 16 1 1 Pancreatic Tuberculosis 1 1 Benign Epithelial Tumor 3 2 1 Serous Cystadenoma 2 1 Endoscopic Ultrasound Characteristics of Study Subjects Among 203 patients, the median strain rate was 27.05 in the malignant group and 20.00 in the non-malignant group. The median strain rate test results for both groups exhibited abnormal outliers, attributed to the excessive disparity between strain rate extremes causing extreme rank orderings, rendering the findings unreliable (U- =3024.5000, P=0.0226). In the malignant group, 0% scored <3 points on the elastography assessment, while 100% scored ≥3 points;In the non-malignant group, <3 points accounted for 7.41% and ≥3 points for 92.59%, with a statistically significant intergroup difference ( P <0.01). Contrast enhancement results in the malignant group showed: no enhancement 9.09%, isointense 3.41%, hypointense 80.11%, hyperintense 7.39%;In the non-malignant group, the proportions were 11.11% for no enhancement, 3.70% for isointense, 74.07% for hypointense, and 11.11% for hyperintense. The difference in contrast enhancement distribution between the two groups was statistically significant (P=0.0207).The median maximum diameter of lesions in the malignant group was 35.70 mm, compared to 25.30 mm in the non-malignant group. The median maximum diameter test results exhibited abnormal outliers in both groups, attributed to the large sample sizes (176 and 27 respectively), yielding statistically significant intergroup differences (U=3416.0000, P<0.01*).In the malignant group, pancreatic lesions were distributed as follows: 46.02% in the head and neck region and 53.98% in the body and tail region. In the non-malignant group, 70.37% of lesions were located in the head and neck region and 29.63% in the body and tail region. The difference in lesion distribution between groups was statistically significant (χ²=6.3677, P=0.0116). See Table 4 for details. Table 4 Characteristics of the Patients' Ultrasonographic Endoscopic Profiles Variable Non-malignant (n=27) Malignant (n=176) Statistic P Maximum Diameter (mm) 25.30 (20.55, 33.55) 35.70 (28.18, 43.50) U = 3416.0000 <0.01* Strain Ratio (SR) 20.00 (14.62, 27.05) 27.05 (20.25, 44.15) U = 3024.5000 0.0226* Lesion Location χ² = 6.3677 0.0116* Head/Neck 19 (70.37%) 81 (46.02%) Body/Tail 8 (29.63%) 95 (53.98%) Elastography Score - <0.01* <3 2 (7.41%) 0 (0.00%) ≥3 25 (92.59%) 176 (100%) Contrast Enhancement - 0.0207* Non-enhancement 3 (11.11%) 16 (9.09%) Isoenhancement 1 (3.70%) 6 (3.41%) Hypoenhancement 20 (74.07%) 141 (80.11%) Hyperenhancement 3 (11.11%) 13 (7.39%） Note: U : Mann-Whitney U test, χ²: Chi-square test, -: Fisher's exact test, *P <0.05 indicates statistically significant difference. Diagnostic Value of EUS-E , CE-EUS, and Their Combination for Pancreatic Solid Lesions EUS-E defined pancreatic malignancy as an elastography score ≥3. Calculating elastography scores yielded an accuracy of 0.88 for distinguishing benign from malignant pancreatic solid lesions, with a sensitivity of 1.00, specificity of 0.07, positive predictive value of 0.88, and negative predictive value of 1.00.with an AUC (95% CI) of 0.56 (0.41–0.68).The semi-quantitative analysis of EUS-E strain rate ratio revealed a median SR of 18.80 in the non-malignant group and 27.48 in the malignant group. The SR for non-malignant lesions was significantly lower than that for malignant lesions (P＜0.01). At the maximum Jorden index (0.37),the optimal cutoff value was 22.07, yielding an accuracy of 0.69 for distinguishing benign from malignant pancreatic solid lesions. Sensitivity was 0.69, specificity 0.68, positive predictive value 0.94, negative predictive value 0.23, and AUC (95% CI) 0.69 (0.57–0.81).CE-EUS defined low and high enhancement as indicators of pancreatic malignancy. The accuracy of the enhancement pattern in distinguishing benign from malignant pancreatic solid lesions was 0.81,with a sensitivity of 0.90, specificity of 0.19, positive predictive value of 0.88, negative predictive value of 0.23, and AUC (95% CI) of 0.56 (0.43–0.70). The combined group, where both EUS-E and CE-EUS simultaneously diagnosed malignancy, was considered malignant based on SPLs results.The combined group's diagnostic accuracy for distinguishing benign from malignant SPLs was calculated as follows: accuracy 0.81, sensitivity 0.90, specificity 0.22, positive predictive value 0.88, negative predictive value 0.26, AUC (95% CI) 0.58 (0.45–0.72). See Table 5 and Figure 3 for details. Table 5 Diagnostic Efficacy of EUS-E, CE-EUS and Combination for Solid Pancreatic Occupations Sensitivity Specificity Positive Predictive Value Negative Predictive Value Accuracy Area Under the Curve EUS-E 1.00 0.07 0.88 1.00 0.88 0.56 (0.41–0.68) CE-EUS 0.90 0.19 0.88 0.23 0.81 0.56 (0.43–0.70) SR > 22.7 0.69 0.68 0.94 0.23 0.69 0.69 (0.57–0.81) Combined group 0.90 0.22 0.88 0.26 0.81 0.58 (0.45–0.72) Binary Logistic Regression Analysis of Predictive Factors for Pancreatic Cancer Diagnosis This study employed binary logistic regression analysis to identify predictive factors for pancreatic cancer diagnosis. Potential associated variables were initially screened via univariate logistic regression (inclusion criterion: P < 0.2 in univariate analysis), followed by bidirectional stepwise regression to construct a multivariate model and identify independent influencing factors. Univariate analysis revealed that tumour location in the body/tail (OR=3.0866, 95% CI: 1.52–6. 25 , P <0.01), maximum diameter (OR=1.0656, 95% CI: 1.03–1. 10 , P <0.01), and the CE-EUS group (OR=0.5381,95% CI: 0.34–0.86, P < 0.01), and the combined group (OR = 1.9950, 95% CI: 0.67–5.91, P < 0.01) were significantly associated with pancreatic cancer.The EUS-E group exhibited an abnormal outlier, likely due to the presence of zero values in the sample size, rendering the result unreliable. Additionally, a history of tumour disease (OR=0.2566, 95% CI: 0.08–0.84, P=0.0245) showed statistical significance, suggesting a potential confounding effect of tumour history.Other variables, including gender, age, strain rate, BMI, history of diabetes, and smoking status, showed no significant association with pancreatic cancer (all P > 0.05). See Table 6 for details. Table 6 Results of One-way Logistic Regression Analysis for the Diagnosis of Pancreatic Cancer Variable OR 95% CI P-value Strain Ratio 0.9972 0.98-1.07 0.59 Gender 1.0923 0.55-2.16 0.79 a Age 1.0297 0.99-1.06 0.07 b BMI 1.0155 0.92-1.13 0.77 c Diabetes 1.2723 0.52-3.12 0.59 d Tumor History 0.2566 0.08-0.84 0.0245 e Smoking 0.9447 0.48-1.83 0.86 f Lesion Location 3.0866 1.52-6.25 <0.01 g,* Maximum Diameter 1.0656 1.03~1.10 <0.01 h,* EUS-E 10960000000 0.00~Inf <0.01 i,* CE-EUS 0.5381 0.34-0.86 <0.01 j,* Combination 1.995 0.67-5.91 <0.01 k,* Notes: a Compared with females; b Compared with those under 50 years old; c Compared with BMI < 18.5; d Compared with non-diabetics; e compared with no history of malignancy; f compared with non-smokers; g compared with head and neck region; h compared with <20 mm; i compared with EUS-E negative as control; j with CE-EUS negative as control; k with combined diagnosis negative as control; *P <0.05, statistically significant difference significance. Multivariate analysis via bidirectional stepwise regression identified age (OR=2.71, 95% CI: 1.13–6.52, P=0.03), tumour location in the body/tail (OR=0.23, 95% CI: 0.10–0.51, P<0.01 c,* ), combined group (OR=2.68,95% CI: 1.21–5. 95 , P=0.02 ) emerged as risk factors, indicating diagnostic stability for pancreatic cancer after controlling for other variables. BMI grouping did not reach significance in the multivariate model. See Table 7 for details. Table 7 Results of Multifactorial Logistic Regression Analysis for the Diagnosis of Pancreatic Cancer Variable OR 95% CI P-value Age 2.71 1.13~6.52 0.03 a,* BMI 2.27 0.92~5.63 0.08 b Lesion Location 0.23 0.10~0.51 <0.01 c,* Combination Diagnosis 2.68 1.21~5.95 0.02 c,* Note: a Compared with those aged under 50; b Compared with BMI under 18.5; c Compared with head and neck region; d Compared with negative combined diagnosis. *P <0.05 indicates statistically significant differences. Discussion Distinguishing benign from malignant pancreatic solid lesions remains a core clinical challenge, directly influencing treatment strategies and patient prognosis. Pancreatic cancer, the most prevalent pathological type, exhibits a global five-year survival rate of 10%, 13% in the United States, whereas China reports rates of 7.2–8.5% [17,18] .Patients with metastatic pancreatic cancer have a median survival of merely 3–6 months, with stage IV patients exhibiting a five-year survival rate as low as 1.3% [19,20] .Conventional CT and MRI scans have limited capability in characterising minute lesions, while EUS-FNA is an invasive procedure with limitations such as technical barriers and sampling errors [21] , and some patients cannot tolerate the examination.Prior to definitive diagnosis, patients with pancreatic masses often require prolonged, repeated imaging examinations and even multiple biopsies. This not only increases financial burden but also prolongs diagnostic delays, hindering timely intervention. Consequently, exploring methods to achieve definitive diagnosis in a single examination holds significant importance for improving patient care, reducing economic strain, and enhancing prognosis.Against this backdrop, EUS-E and CE-EUS offer novel approaches to addressing early pancreatic lesion diagnosis by leveraging complementary tissue mechanical properties and blood flow perfusion characteristics. EUS-E distinguishes benign from malignant lesions by assessing tissue hardness variations, finding extensive application in diagnosing various conditions. It demonstrates particularly high accuracy in differentiating benign from malignant lesions in the pancreas and lymph nodes [22–24] .This study demonstrates that the diagnostic sensitivity of the elastography score for malignant pancreatic lesions reaches 100%, with a negative predictive value of 1.00. This implies that an EUS-elastography score <3 points virtually excludes malignancy.This aligns with a meta-analysis of 19 studies involving 1,687 patients, which reported a sensitivity of 0.98 for EUS-E in diagnosing malignant pancreatic masses [25] . Other studies have similarly demonstrated that elasticity-guided EUS-FNA achieves 100% sensitivity for detecting malignant pancreatic lesions [26] .The high sensitivity of EUS elastography indicates its exceptional reliability in ruling out malignant tumours, particularly crucial for screening highly malignant tumours such as pancreatic cancer [27] . Considering the limitations of qualitative scoring, namely its high subjectivity and difficulty in standardisation, this study further introduced SR as a semi-quantitative indicator. Results showed that the median SR for malignant lesions was 27.48, significantly higher than the median SR of 18.80 for non-malignant lesions (P < 0.01).The optimal SR cutoff value was 22.27, yielding 69% diagnostic accuracy and an AUC of 0.69, indicating its auxiliary value in distinguishing pancreatic lesion characteristics.Although optimal SR cut-off values for diagnosing pancreatic malignancy vary across studies, the overall trend indicates that higher SR values correlate with increased malignant risk in pancreatic lesions [28–31] . It is evident that EUS-E possesses inherent limitations. Its 19% specificity suggests it may misclassify non-malignant lesions (such as mass-type pancreatitis or fibrotic foci) as malignant, thereby increasing the rate of misdiagnosis in clinical practice.Previous studies have indicated that the elastic characteristics of nodular pancreatitis and pancreatic neuroendocrine tumours may overlap with those of pancreatic ductal adenocarcinoma, leading to false-positive results. Furthermore, pancreatic fibrosis increases tissue stiffness, thereby interfering with the ability of elastography to distinguish between benign and malignant lesions [29,32] .The higher sensitivity observed in this study may relate to the exceptionally high proportion of malignant tumours (86.70%) among included cases and operator expertise. Moreover, the accuracy of elastography findings is influenced by multiple factors, including operator experience and technical proficiency, lesion location, and size, with such variations potentially contributing to inconsistent results [29,33] . CE-EUS, utilising intravenous microbubble contrast agents to visualise real-time blood flow perfusion patterns, serves as a crucial tool for assessing tumour vascularity [34] . Unlike EUS-E, which focuses on stiffness, CE-EUS employs second-generation contrast agents to observe microvascular distribution in real-time under EUS guidance, aiding in the identification of typical features in pancreatic cancer such as low enhancement and avascularity.Studies indicate that pancreatic cancer predominantly exhibits a hypoenhancement pattern, whereas neuroendocrine tumours often show hyperenhancement, and inflammatory lesions may present with isointense or hyperintense enhancement 26,34–37 . Multiple studies demonstrate that the low-enhancement pattern defined by CE-EUS holds significant diagnostic value for differentiating SPLs from pancreatic malignancies [39–43] . Two meta-analyses (n=2807) reported pooled sensitivity and specificity of CE-EUS for SPL differentiation at 93%–94% and 88%-89%, respectively [44,45] . In the present study, CE-EUS demonstrated high sensitivity in distinguishing benign from malignant SPLs, with enhancement patterns closely correlated to lesion malignancy and histopathological type.Pancreatic cancer predominantly exhibits low enhancement, reflecting its characteristic pathologic features of avascularity, uneven perfusion, and reduced microvascular density. Non-malignant lesions predominantly show isointense enhancement, with some demonstrating no enhancement, suggesting local necrosis or inflammatory congestion. Given the considerable variability in histology and haemoperfusion among pancreatic solid lesions, a single imaging modality often fails to comprehensively capture all lesion characteristics.EUS-E focuses on tissue stiffness, while CE-EUS provides vascular information. Their combination enables a dual-dimensional assessment of structure and function, compensating for the limitations of individual techniques. Multiple studies have demonstrated that this combination effectively enhances diagnostic performance [45–48] . However, these studies suffer from small sample sizes and high heterogeneity, resulting in limited comparability of findings. This prospective study prospectively enrolled 203 patients with SPLs. Pancreatic lesions were classified as malignant when the EUS-E score was ≥3 and CE-EUS demonstrated low or high enhancement; all other patients were defined as non-malignant based on combined diagnosis.Results demonstrated that the combined application of EUS-E and CE-EUS achieved an accuracy of 88%, sensitivity of 90%, specificity of 22%, positive predictive value (PPV) of 88%, and negative predictive value (NPV) of 26% in distinguishing pancreatic solid lesions.demonstrating superior overall diagnostic performance compared to individual modalities. The AUC reached 0.58, indicating high clinical utility for this combined approach in distinguishing benign from malignant pancreatic solid lesions.This aligns with findings from Shin et al.'s meta-analysis, which reported combined sensitivity of 84% and specificity of 85% for EUS-E and CE-EUS [49] , further validating the reliability and universality of this combined strategy.Although the specificity was relatively low, it can still help identify false-positive results. Some people with malignant tumors may have been misdiagnosed as having benign tumors. However, the PPV is 88%, which indicates that the test's positive results are very accurate. This can provide reliable evidence for surgical decisions.Moreover, multivariate logistic regression analysis indicated that combined diagnostic results constitute an independent risk factor for pancreatic cancer (OR=2.68, 95% CI: 1.21–5. 95 , P <0.01). This demonstrates the model's stable independent predictive power after controlling for other variables, further supporting the application potential of combined diagnosis in early pancreatic cancer screening and clinical decision-making. Innovation and strengths of this study: This study innovatively combined EUS-E and CE-EUS to assess the benignity or malignancy of SPLs, addressing the limitations of previous single-technique studies.Accuracy and reliability were ensured by establishing standardised combined diagnostic thresholds (EUS-E score ≥ 3 and CE-EUS showing low/high enhancement) against pathology or long-term follow-up as the gold standard. Furthermore, its prospective design and standardised data collection enhanced scientific rigour.However, this study has certain limitations.: single-centre origin may introduce selection bias, affecting generalisability; relatively few benign lesions may impact assessment of specificity and other metrics; and image interpretation remains subjective, lacking uniform quantitative standards. Declarations Ethical Approval This prospective observational study was approved by the Ethics Committee of Guizhou Medical University Cancer Hospital (Ethics Approval Number: SL-202104092), all patients have signed informed consent, and all methods were performed in accordance with the relevant guidelines and regulations. Conflicts of Interest The authors declare no competing interests. Funding This study is supported by Guizhou Provincial Science and Technology Foundation (Grant Number: gzwkj2024-080), Guizhou Clinical Research Center for Digestive Diseases [grant no. Qian Ke He Platform-LCZX (2025) 001]. Data availability The datasets generated during and/or analyzed during the current study are not publicly available due to including personal medical and life information. But the datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Authors' contributions Conceptualization, P.L., Z.L. and W.Z.; methodology, P.L., T.D. and Z.L.; writing—original draft preparation, C.X.Z., R.X.S. and T.T.H.; writing—review and editing, W.Z., and Q.L.; supervision, W.Z. and Z.L ; funding acquisition, W.Z. All authors have read and agreed to the published version of the manuscript. References Dietrich CF, Hocke M. Elastography of the Pancreas, Current View. Clin Endosc . 2019;52(6):533-540. doi:10.5946/ce.2018.156 Wood LD, Canto MI, Jaffee EM, Simeone DM. Pancreatic Cancer: Pathogenesis, Screening, Diagnosis, and Treatment. 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Prediagnostic Image Data, Artificial Intelligence, and Pancreatic Cancer: A Tell-Tale Sign to Early Detection. Pancreas . 2020;49(7):882-886. doi:10.1097/MPA.0000000000001603 Facciorusso A, Crinò SF, Ramai D, et al. Comparative diagnostic performance of different techniques for EUS-guided fine-needle biopsy sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc . 2023;97(5):839-848.e5. doi:10.1016/j.gie.2023.01.024 Iglesias-Garcia J, De La Iglesia-Garcia D, Lariño-Noia J, Dominguez-Muñoz JE. Endoscopic Ultrasound (EUS) Guided Elastography. Diagnostics . 2023;13(10):1686. doi:10.3390/diagnostics13101686 Kitano M, Yoshida T, Itonaga M, Tamura T, Hatamaru K, Yamashita Y. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol . 2019;54(1):19-32. doi:10.1007/s00535-018-1519-2 Zhang B, Zhang C, Li P, Zhu F. Diagnostic Value of Qualitative and Quantitative Endoscopic Ultrasound Elastography for the Evaluation of Lymph Nodes: A Meta-analysis. J Gastrointestin Liver Dis . 2024;33(4):563-570. doi:10.15403/jgld-5754 Zhang B, Zhu F, Li P, Yu S, Zhao Y, Li M. Endoscopic ultrasound elastography in the diagnosis of pancreatic masses: A meta-analysis. Pancreatology . 2018;18(7):833-840. doi:10.1016/j.pan.2018.07.008 Nayak HK, Rai A, Gupta S, et al. Endoscopic ultrasound (EUS) elastography-guided fine-needle aspiration cytology (FNAC) versus conventional EUS FNAC for solid pancreatic lesions: A pilot randomized trial. Indian J Gastroenterol . 2025;44(6):872-877. doi:10.1007/s12664-024-01673-4 Salom F, Prat F. Current role of endoscopic ultrasound in the diagnosis and management of pancreatic cancer. World J Gastrointest Endosc . 2022;14(1):35-48. doi:10.4253/wjge.v14.i1.35 Puga-Tejada M, Del Valle R, Oleas R, et al. Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value. World J Gastrointest Endosc . 2022;14(9):524-535. doi:10.4253/wjge.v14.i9.524 Cho IR, Jeong SH, Kang H, et al. Diagnostic performance of endoscopic ultrasound elastography for differential diagnosis of solid pancreatic lesions: A propensity score-matched analysis. Pancreatology . 2023;23(1):105-111. doi:10.1016/j.pan.2022.12.002 Hepatogastroenterology Unit, Department of Internal Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt, Okasha HH, El-Amin H, et al. Role of Endoscopic Ultrasound Elastography Strain Histograms in the Evaluation of Patients with Pancreatic Masses. Turk J Gastroenterol . 2021;32(6):519-525. doi:10.5152/tjg.2021.20678 Kumar S, Yaseen T, Tasneem AA, et al. Role of Endoscopic Ultrasound in Predicting Solid Pancreatic Lesions Using Strain Ratio and Elastography. Euroasian J Hepato-Gastroenterol . 2023;13(1):1-4. doi:10.5005/jp-journals-10018-1386 Nakaoka K, Hashimoto S, Miyahara R, et al. Current status of the diagnosis of chronic pancreatitis by ultrasonographic elastography. Korean J Intern Med . 2022;37(1):27-36. doi:10.3904/kjim.2021.252 Kaya M, Gürün E. Do deep inspiration breath-holds and free-breathing affect pancreatic tissue stiffness in shear wave elastography? Abdom Radiol . 2022;47(7):2390-2396. doi:10.1007/s00261-022-03535-z Giovannini M. Contrast-enhanced endoscopic ultrasound and elastosonoendoscopy. Best Pract Res Clin Gastroenterol . 2009;23(5):767-779. doi:10.1016/j.bpg.2009.05.004 Wang Y, Li G, Yan K, et al. Clinical value of contrast-enhanced ultrasound enhancement patterns for differentiating solid pancreatic lesions. Eur Radiol . 2022;32(3):2060-2069. doi:10.1007/s00330-021-08243-8 Ishii T, Katanuma A, Toyonaga H, et al. Role of Endoscopic Ultrasound in the Diagnosis of Pancreatic Neuroendocrine Neoplasms. Diagnostics . 2021;11(2):316. doi:10.3390/diagnostics11020316 Tamura T, Sugihara Y, Yamazaki H, et al. Contrast-Enhanced Harmonic Endoscopic Ultrasound for Diagnosis of the Aggressiveness of Pancreatic Neuroendocrine Neoplasm. Diagnostics . 2022;12(12):2988. doi:10.3390/diagnostics12122988 Chen X, Hao F, Gui Y, et al. Enhancement patterns in the venous phase of contrast-enhanced ultrasounds: diagnostic value for patients with solid pancreatic lesions. Quant Imaging Med Surg . 2021;11(10):4321-4333. doi:10.21037/qims-20-1248 Omoto S, Kitano M, Fukasawa M, et al. Tissue harmonic versus contrast‐enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic tumors: Prospective multicenter study. Dig Endosc . 2022;34(1):198-206. doi:10.1111/den.13944 Gincul R, Palazzo M, Pujol B, et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy . 2014;46(05):373-379. doi:10.1055/s-0034-1364969 Teodorescu C, Bolboaca SD, Rusu I, et al. Contrast enhanced endoscopic ultrasound in the diagnosis of pancreatic metastases. Med Ultrason . Published online April 14, 2022. doi:10.11152/mu-3495 Harmsen FJ, Domagk D, Dietrich C, Hocke M. Discriminating chronic pancreatitis from pancreatic cancer: Contrast-enhanced EUS and multidetector computed tomography in direct comparison. Endosc Ultrasound . 2018;7(6):395. doi:10.4103/eus.eus_24_18 Mei S, Wang M, Sun L. Contrast-Enhanced EUS for Differential Diagnosis of Pancreatic Masses: A Meta-Analysis. Gastroenterol Res Pract . 2019;2019:1-9. doi:10.1155/2019/1670183 He XK, Ding Y, Sun LM. Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis. Oncotarget . 2017;8(39):66392-66401. doi:10.18632/oncotarget.18915 Gong T ting, Hu D min, Zhu Q. Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: a meta-analysis. Gastrointest Endosc . 2012;76(2):301-309. doi:10.1016/j.gie.2012.02.051 Săftoiu A, Iordache S, Gheonea DI, et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc . 2010;72(4):739-747. doi:10.1016/j.gie.2010.02.056 Iglesias‐Garcia J, Lindkvist B, Lariño‐Noia J, Abdulkader‐Nallib I, Dominguez‐Muñoz JE. Differential diagnosis of solid pancreatic masses: contrast‐enhanced harmonic (CEH‐EUS), quantitative‐elastography (QE‐EUS), or both? United Eur Gastroenterol J . 2017;5(2):236-246. doi:10.1177/2050640616640635 Costache M, Cazacu I, Dietrich C, et al. Clinical impact of strain histogram EUS elastography and contrast-enhanced EUS for the differential diagnosis of focal pancreatic masses: A prospective multicentric study. Endosc Ultrasound . 2020;9(2):116. doi:10.4103/eus.eus_69_19 Shin CM, Villa E. The efficiency of contrast-enhanced endoscopic ultrasound (EUS) combined with EUS elastography for pancreatic cancer diagnosis: a systematic review and meta-analysis. Ultrasonography . 2023;42(1):20-30. doi:10.14366/usg.22103 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 06 May, 2026 Editor invited by journal 15 Apr, 2026 Editor assigned by journal 14 Apr, 2026 Submission checks completed at journal 14 Apr, 2026 First submitted to journal 12 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9395390","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639532578,"identity":"7afed508-17cf-4782-8a7f-6534afc9aa48","order_by":0,"name":"Caixia Zhao","email":"","orcid":"","institution":"The First People's Hospital of Guiyang","correspondingAuthor":false,"prefix":"","firstName":"Caixia","middleName":"","lastName":"Zhao","suffix":""},{"id":639532579,"identity":"3173c74e-764f-4534-9ea5-52e970d12c36","order_by":1,"name":"Rongxing Shi","email":"","orcid":"","institution":"Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rongxing","middleName":"","lastName":"Shi","suffix":""},{"id":639532580,"identity":"d9f5d1eb-dfd3-432c-802f-3b036b753992","order_by":2,"name":"Tingting He","email":"","orcid":"","institution":"Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tingting","middleName":"","lastName":"He","suffix":""},{"id":639532581,"identity":"f8f332de-3e8f-4a96-9559-1511bc58bf2e","order_by":3,"name":"Qin Lu","email":"","orcid":"","institution":"Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Lu","suffix":""},{"id":639532582,"identity":"b5abe82a-8a6c-4496-aaeb-560dd430859a","order_by":4,"name":"Zhe Liu","email":"","orcid":"","institution":"The Affiliated Tumor Hospital of Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhe","middleName":"","lastName":"Liu","suffix":""},{"id":639532583,"identity":"5aca936c-86c5-42a8-a2be-0f3e76206943","order_by":5,"name":"Peng Liu","email":"","orcid":"","institution":"The Affiliated Tumor Hospital of Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Liu","suffix":""},{"id":639532584,"identity":"8d78f1cc-6095-4105-84ff-8e9d884bcc7b","order_by":6,"name":"Ting Dai","email":"","orcid":"","institution":"The Affiliated Tumor Hospital of Guizhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Dai","suffix":""},{"id":639532585,"identity":"c93985f1-6318-4b88-8f0d-0c6fe66c82d3","order_by":7,"name":"Wei Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACxvkP0j98/GPDw0+0FuaGhGeMMxvSZCQbiNXC3pD4jJm34bCNwQFitQBVpz2cueMwj/Hx5A0MPyq2EdYi2diWbvDxTDqP2ZlnBYw9Z24T1mLYzJMgOYPNmsfsRo4BM2MbEVrsj/F/kOZhY+YxnkGsFsYehjRp3jZnHgMJorXMYEg2nHEmjUcC6JeDRPkFqCXxwYcKG3v+9uSND35UEKEFCSQQHzUILaTqGAWjYBSMghECAEcPP9lw3XhsAAAAAElFTkSuQmCC","orcid":"","institution":"Guizhou Medical University Affiliated Hospital \u0026 Gui Zhou Hospital the First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-04-12 15:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9395390/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9395390/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109297797,"identity":"c8662364-a63e-4db8-ad48-e66e2852162a","added_by":"auto","created_at":"2026-05-15 09:05:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33079,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEndoscopic Ultrasound Elastography Images of Typical Solid Pancreatic Lesions \u003c/strong\u003eA: 70-year-old female patient. Elastography of pancreatic tail lesion showed hard texture with score 4 and strain rate 23.07; pathology confirmed pancreatic carcinoma. B: 64-year-old male patient. Elastography of pancreatic head lesion showed soft texture with score 2 and strain rate 7.49; pathology confirmed inflammatory lesion.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9395390/v1/1eba2de62b930d13489817d7.jpg"},{"id":109269137,"identity":"7e807e49-4f27-4369-8a28-20ccbcbea949","added_by":"auto","created_at":"2026-05-14 13:26:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19674,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eContrast-enhanced endoscopic ultrasound images of typical solid pancreatic lesions.\u003c/strong\u003e A:79-year-old female patient with a pancreatic head lesion showing low enhancement on contrast-enhanced ultrasound; pathological findings confirmed pancreatic carcinoma. B: 49-year-old female patient with a pancreatic body lesion showing no enhancement on contrast-enhanced endoscopic ultrasound; pathological findings confirmed tuberculosis.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9395390/v1/49b2faba7a6f144c9eb08a07.jpg"},{"id":109269139,"identity":"10078186-2eb0-4405-98f0-4711697e0292","added_by":"auto","created_at":"2026-05-14 13:26:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15961,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC Curves for the Diagnosis of Solid Pancreatic Occupations by EUS-E, CE-EUS and Combined EUS-E and CE-EUS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9395390/v1/081b553b4c8cf013f3ad2e50.jpg"},{"id":109269136,"identity":"671331b7-a631-4431-951a-c9e30798e600","added_by":"auto","created_at":"2026-05-14 13:26:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448762,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9395390/v1/71fddb8f-bfae-4b37-82cb-d21c17d794e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Value of Combined Endoscopic Ultrasound Elastography and Contrast-Enhanced Ultrasound in Solid Pancreatic Lesions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSolid pancreatic lesions (SPLs) primarily originate from the exocrine and endocrine tissues of the pancreas, encompassing pancreatic ductal adenocarcinoma (PDAC), neuroendocrine tumours, solid pseudopapillary tumours, pancreatic blastoma, pancreatic lymphoma, and metastatic pancreatic tumours, among others\u0026nbsp;\u003csup\u003e[1]\u003c/sup\u003e.Due to its unique anatomical location and histological characteristics, coupled with relative insensitivity to pain stimuli, pancreatic diseases often present insidiously in their early stages with non-specific clinical manifestations. This contributes to the highly invasive nature and extremely poor prognosis of pancreatic cancer, making it one of the leading causes of cancer-related mortality globally\u003csup\u003e[2–4]\u003c/sup\u003e.Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is frequently employed as the primary diagnostic modality for pancreatic masses in clinical practice\u0026nbsp;\u003csup\u003e[5]\u003c/sup\u003e. However, EUS-FNA carries risks of multiple complications, including acute pancreatitis, haemorrhage, infection, and needle-track implantation metastasis\u0026nbsp;\u003csup\u003e[6–8]\u003c/sup\u003e.Moreover,\u0026nbsp;its diagnostic performance diminishes in the context of chronic pancreatitis\u0026nbsp;\u003csup\u003e[9]\u003c/sup\u003e.\u0026nbsp;With advances in endoscopic technology, novel\u0026nbsp;EUS-based\u0026nbsp;imaging diagnostic methods have emerged, giving rise to two new approaches:\u0026nbsp;Endoscopic ultrasound elastography (EUS-E)\u0026nbsp;and\u0026nbsp;contrast-enhanced endoscopic ultrasound (CE-EUS). Both enable non-invasive differentiation of pancreatic lesions, providing more precise imaging support for clinical decision-making.\u0026nbsp;EUS-E\u0026nbsp;quantifies tissue stiffness variations through mechanical stimulation combined with ultrasonic signal analysis, offering crucial supplementary information for distinguishing benign from malignant lesions in the digestive tract and adjacent organs. Based on tissue stiffness and elasticity characteristics,\u0026nbsp;Giovannini\u0026nbsp;et al. proposed a five-point\u0026nbsp;elastography\u0026nbsp;scoring system\u0026nbsp;\u003csup\u003e[10]\u003c/sup\u003e, where scores\u0026nbsp;≥3\u0026nbsp;suggest malignant lesions, while scores \u0026lt;2 typically indicate benign lesions\u0026nbsp;\u003csup\u003e[11,12]\u003c/sup\u003e.Semi-quantitative analysis employs\u0026nbsp;the strain ratio (SR),\u0026nbsp;calculated as SR_(lesion)/SR_(peripheral\u0026nbsp;tissue). Studies indicate that\u0026nbsp;benign pancreatic lesions\u0026nbsp;exhibit significantly lower\u0026nbsp;SR values\u0026nbsp;than malignant lesions,\u0026nbsp;with\u0026nbsp;median\u0026nbsp;SR values\u0026nbsp;of\u0026nbsp;7.33\u0026nbsp;for\u0026nbsp;benign versus 20.07 for malignant lesions\u003csup\u003e[12]\u003c/sup\u003e.CE-EUS\u0026nbsp;employs intravenous injection of second-generation microbubble contrast agents\u0026nbsp;(e.g.,\u0026nbsp;Sonazoid or SonoVue). These microbubbles distribute intravascularly and enhance blood flow signals, thereby visualising target organ vascular distribution and perfusion patterns\u0026nbsp;\u003csup\u003e[13,14]\u003c/sup\u003e.The combined application of\u0026nbsp;EUS-E and CE-EUS\u0026nbsp;enables simultaneous assessment of lesion tissue stiffness and microvascular perfusion characteristics, conducting a more comprehensive differential diagnosis of SPLs.\u0026nbsp;While this\u0026nbsp;combined approach demonstrates potential in\u0026nbsp;diagnosing pancreatic solid lesions, its application remains challenging. Due to its operational complexity, high cost, and insufficient training, this technique is currently limited to a small number of large hospitals in China. Consequently, related research remains scarce, predominantly consisting of small-sample retrospective analyses, with evidence quality and generalisability requiring improvement\u003csup\u003e[15]\u003c/sup\u003e .This study evaluates the performance of elastic imaging scores, SR, and contrast-enhanced imaging in diagnosing SPLs in patients who were treated at our hospital. The aim is to improve the accuracy of the initial diagnosis of patients with pancreatic solid lesions, provide reliable information for subsequent treatment plans, reduce unnecessary examinations, shorten the diagnostic and treatment cycle, and improve patient management and prognosis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom September 2022 to December 2025, patients who were diagnosed with pancreatic masses through abdominal ultrasound, CT, MRI, or EUS examinations, but whose diagnoses were not confirmed, were referred to the Endoscopy Center at the Guizhou University of Traditional Chinese Medicine Affiliated Hospital for further evaluation and successful CE-EUS and EUS-E examinations.Patient demographics collected included: admission number, telephone number, gender, age, body mass index (BMI), smoking history, diabetes history, and tumour history. Endoscopic ultrasound data comprised: pancreatic mass location, size, elastography images with scoring, shear rate (SR), and contrast enhancement patterns.This prospective observational study was approved by the Ethics Committee of Guizhou Medical University Cancer Hospital (Ethics Approval Number: SL-202104092).\u003c/p\u003e\n\u003cp\u003enclusion Criteria\u003c/p\u003e\n\u003cp\u003e(1) Patients with pancreatic space-occupying lesions identified by conventional imaging studies where the nature of the lesion remained unclear; (2) Patients without contraindications for EUS and who signed the relevant informed consent form; (3) EUS findings indicating solid or predominantly solid-cystic lesions;(4) Diagnosis of pancreatic lesions confirmed by one of the following methods: pathological examination following surgical resection, EUS-guided fine-needle aspiration (EUS-FNA), or comprehensive clinical diagnosis (including imaging studies, laboratory tests, and clinical characteristics).\u003c/p\u003e\n\u003cp\u003eExclusion Criteria\u003c/p\u003e\n\u003cp\u003e(1) Patients with EUS findings indicating entirely or predominantly cystic pancreatic lesions; (2) Incomplete or missing data; (3) Patients with severe cardiopulmonary or neurological conditions rendering them intolerant to EUS or intravenous anaesthesia;(4) Patients with acute oropharyngeal or oesophageal injury posing a high risk of endoscopic perforation; (5) Patients with severe psychiatric disorders rendering them non-cooperative; (6) Pregnant or lactating women; (7) Patients with contrast medium allergy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEquipment and Reagents: Ultrasound endoscope: GF-UCT260-AL5 (Olympus, Tokyo, Japan). Ultrasound endoscope control unit: EU-ME2 PREMIER PLUS (Olympus, Tokyo, Japan). Ultrasound contrast agent: SonoVue (sulphur hexafluoride microbubbles, Bracco, Italy).\u0026nbsp;Each vial contained 25 mg lyophilised powder dissolved in 5 ml saline solution, shaken to form a suspension. 2.4 ml was rapidly injected via the antecubital vein, followed by 5 ml saline solution for flushing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEndoscopic Ultrasound Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePre-examination Preparation: Patient preparation: Fasting for 6–8 hours and no fluid intake for 4 hours prior to examination; informed consent obtained. Sedation and analgesia: Pharyngeal local anaesthesia (lidocaine gel), intravenous sedation (midazolam), with continuous ECG monitoring throughout.\u003c/p\u003e\n\u003cp\u003eProcedure: Conventional EUS: Enter the gastric cavity transorally, adjust position to localise the pancreas. Employ grey-scale ultrasound and colour Doppler to evaluate lesion morphology and blood flow distribution. Elastography Mode Switch: Activate elastography function, select region of interest (ROI) covering the lesion and surrounding normal pancreatic tissue. Hardness Analysis: Image Interpretation: Blue: High tissue stiffness; Green/Red: Softer tissue.Semi-quantitative parameters: Elastic strain ratio; Dynamic compression: Apply gentle endoscopic pressure to stabilise elastic signals (avoid excessive pressure causing error). Collect and analyse recorded EUS elastography images and SR values, then perform elastography scoring. Ultrasound Contrast Enhancement: Administer Sonovue intravenously, immediately initiating contrast mode to synchronously record arterial phase (10–30 seconds) and venous phase (30–120 seconds). Assess enhancement patterns of pancreatic masses relative to surrounding parenchyma (no enhancement, low enhancement, equal enhancement, high enhancement).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation of Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEUS Elastography (EUS-E): Employ a five-point scoring system: Score 1 (entirely green), Score 2 (blue-green mixed with predominant green), Score 3 (predominantly blue with peripheral green), Score 4 (almost entirely blue with minor mottling), Score 5 (predominantly blue with coarse red/green streaks and peripheral blue); a score ≥3 indicates malignancy.\u003c/p\u003e\n\u003cp\u003eContrast-enhanced EUS (CE-EUS): Following the European Federation of Ultrasound in Medicine and Biology (EFUMAB) criteria\u0026nbsp;\u003csup\u003e[16]\u003c/sup\u003e, contrast enhancement is assessed in arterial and venous phases. The arterial phase is graded as high/equal/low/no enhancement based on echogenicity intensity; the venous phase evaluates diffuse enhancement (echogenicity ≥ surrounding tissue). Low or high arterial enhancement is interpreted as malignant.\u003c/p\u003e\n\u003cp\u003eCombined Diagnosis: EUS-E score ≥3 points with CE-EUS showing low/high enhancement defined as combined positive; all others as combined negative. Images were independently interpreted by two physicians, with discrepancies resolved through discussion or third-party adjudication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal Diagnosis (Gold Standard):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Surgical pathology/immunohistochemistry. (2) Definitive evidence of malignancy based on histopathology from EUS-FNA; cases inconclusive for diagnosis shall be assessed comprehensively using clinical and imaging/tumour marker data, followed by ≥6 months of follow-up: progression/metastasis indicates malignancy; stable disease without progression indicates non-malignancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS 26.0 and R 4.3.0 statistical software. Count data were expressed as case numbers or percentages, with intergroup comparisons conducted using \u003cstrong\u003e\u003cem\u003eχ²\u0026nbsp;\u003c/em\u003e\u003c/strong\u003etest or Fisher's exact test. Continuous variables meeting normal distribution were presented as mean ± standard deviation, with intergroup comparisons using independent \u003cem\u003esamples\u0026nbsp;\u003c/em\u003et-tests; non-normally distributed continuous variables were presented as median (interquartile range), with intergroup comparisons using Fisher's exact test or Mann-Whitney \u003cem\u003eU\u0026nbsp;\u003c/em\u003etest. P\u003cem\u003e\u0026nbsp;\u0026lt; 0.05\u0026nbsp;\u003c/em\u003eindicated statistically significant differences. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for EUS-E, CE-EUS, and their combined diagnosis, using the final diagnostic outcome as the gold standard. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) with its 95% confidence interval was calculated. Logistic regression was employed to identify independent factors influencing pancreatic cancer diagnosis. Univariate logistic regression initially screened potential associated variables, followed by a bidirectional stepwise approach to establish a multivariate model and identify independent predictors.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics of the study subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 203 subjects, all of whom underwent EUS-E and CE-EUS examinations. Among these, 188 patients underwent EUS-FNA with histopathological results obtained; 15 patients underwent surgical resection with postoperative pathological results obtained.Pathological diagnosis confirmed pancreatic cancer in 158 patients, metastatic cancer in 6 (originating from rectum, breast, ovary, and bile duct respectively), while the remaining 24 patients had negative or indeterminate pathological results. Following at least 6 months of follow-up, the final diagnosis was confirmed:Among these, 12 cases were malignant: 7 pancreatic neuroendocrine tumours, 1 pancreatic neuroendocrine carcinoma, 1 pancreatic solid pseudopapillary tumour, 1 high-grade ductal intraepithelial neoplasia, 1 pancreatic adenocarcinoma, and 1 pancreatic mucinous epithelial tumour.27 non-malignant cases comprised 20 pancreatic inflammatory masses, 1 pancreatic tuberculosis, 3 benign pancreatic epithelial tumours, 1 pancreatic abscess, and 2 pancreatic serous cystadenomas. See Table 1 for details.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the 203 patients, 176 (86.70%) were ultimately diagnosed with malignant lesions, while non-malignant lesions accounted for 13.30%. Among malignant patients, BMI distribution showed: \u0026lt;18.50 kg/m\u0026sup2; accounted for 16.48%; 18.50\u0026ndash;25.00 kg/m\u0026sup2; constituted 67.05%; \u0026ge;25 kg/m\u0026sup2; comprised 16.48%.Among patients with a final clinical diagnosis of non-malignant lesions, BMI distribution was as follows: \u0026lt;18.50 kg/m\u0026sup2; (18.52%), 18.50\u0026ndash;25.00 kg/m\u0026sup2; (70.37%), \u0026ge;25 kg/m\u0026sup2; (11.11%).The difference in gender distribution between the two groups was statistically significant (P=0.0497). No statistically significant differences were observed between the two groups in age distribution, presence of diabetes, history of tumours, or smoking status (all P\u0026gt;0.05). See Table 1 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Characteristics of the Patients\u0026rsquo; Clinical Data and Distribution of Diagnoses\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eNon-malignant (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eMalignant (n=176)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e57.59 \u0026plusmn; 12.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60.88 \u0026plusmn; 10.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eT = -1.5339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.1266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBMI (Kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eT = 1.1966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.2329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e＜18.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (18.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e29 (16.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18.50-25.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (70.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e118 (67.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026ge;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e29 (16.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 3.8524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0497*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (22.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e74 (42.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (77.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e102 (57.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e22 (81.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e144 (81.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (18.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32 (18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTumor History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.6637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e25 (92.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e166 (94.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (5.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSmoking History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.7540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.3852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e94 (53.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e82 (46.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFinal Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eInflammatory Mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20 (9.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBenign Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (1.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSerous Cystadenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (0.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e158 (77.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (3.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSolid Pseudopapillary Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHigh-grade Intraepithelial Neoplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMetastatic Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (2.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePancreatic Adenosquamous Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMucinous Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (0.49%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u003cem\u003eT\u003c/em\u003e: T-test, \u0026chi;\u0026sup2;: Chi-square test, -: Fisher\u0026apos;s exact test, \u003cem\u003e*P\u003c/em\u003e\u0026lt;0.05 indicates statistically significant difference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of endoscopic ultrasound data in study subjects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDistribution of Endoscopic Ultrasound Elastography Scores in Study Subjects\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUltrasound endoscopic elastography examinations were performed on patients (as shown in Figure 1). Distribution of elastography scores among 203 patients\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, the cases comprised 158 pancreatic carcinomas, 7 neuroendocrine tumours, 1 pancreatic solid pseudopapillary neoplasm, 1 high-grade ductal intraepithelial neoplasia, 6 metastatic carcinomas,1 case of pancreatic neuroendocrine carcinoma, 1 case of pancreatic tuberculosis, 3 cases of benign pancreatic epithelial tumours, 2 cases of pancreatic serous cystadenoma, 1 case of pancreatic mucinous epithelial tumour, 1 case of pancreatic cyst, and 1 case of pancreatic adenocarcinoma all had Elastography scores \u0026ge;3.Among 20 patients with pancreatic inflammatory masses, 2 scored 2 points, 2 scored 3 points, 7 scored 4 points, and 9 scored 5 points. See Table 2 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Distribution of Elastography Scores for Solid Pancreatic Occupancies of Different Pathologic Types\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePathological Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 378px;\"\u003e\n \u003cp\u003eElastography Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSolid Pseudopapillary Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHigh-grade Intraepithelial Neoplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMetastatic Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMucinous Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Adenosquamous Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eInflammatory Mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePancreatic Tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBenign Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eSerous Cystadenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDistribution of Contrast-Enhanced Patterns in Study Subjects\u003c/p\u003e\n\u003cp\u003eContrast-enhanced endoscopic ultrasound assessment of pancreatic masses (as shown in Figure 2). The contrast enhancement patterns of 203 pancreatic solid lesions with different pathological types are presented in Table 3.Among the 176 patients with a final clinical diagnosis of malignant lesions, 16 exhibited no enhancement, 141 showed low enhancement, 6 demonstrated isoechoic enhancement, and 13 displayed high enhancement. Among the 27 non-malignant lesions, 3 showed no enhancement, 20 exhibited low enhancement, 1 demonstrated isoechoic enhancement, and 3 displayed high enhancement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Distribution of Contrast-Enhancement Patterns in Solid Pancreatic Lesions of Different Pathological Types\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePathological Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 302px;\"\u003e\n \u003cp\u003eContrast-Enhancement Pattern\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNon-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eHypo-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eIso-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eHyper-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSolid Pseudopapillary Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eHigh-grade Intraepithelial Neoplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMetastatic Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Neuroendocrine Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMucinous Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Adenosquamous Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eInflammatory Mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePancreatic Tuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eBenign Epithelial Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSerous Cystadenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEndoscopic Ultrasound Characteristics of Study Subjects\u003c/p\u003e\n\u003cp\u003eAmong 203 patients, the median strain rate was 27.05 in the malignant group and 20.00 in the non-malignant group.\u0026nbsp;The median strain rate test results for both groups exhibited abnormal outliers, attributed to the excessive disparity between strain rate extremes causing extreme rank orderings, rendering the findings unreliable (U- =3024.5000, P=0.0226). In the malignant group, 0% scored \u0026lt;3 points on the elastography assessment, while 100% scored \u0026ge;3 points;In the non-malignant group, \u0026lt;3 points accounted for 7.41% and \u0026ge;3 points for 92.59%, with a statistically significant intergroup difference (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01). Contrast enhancement results in the malignant group showed: no enhancement 9.09%, isointense 3.41%, hypointense 80.11%, hyperintense 7.39%;In the non-malignant group, the proportions were 11.11% for no enhancement, 3.70% for isointense, 74.07% for hypointense, and 11.11% for hyperintense. The difference in contrast enhancement distribution between the two groups was statistically significant (P=0.0207).The median maximum diameter of lesions in the malignant group was 35.70 mm, compared to 25.30 mm in the non-malignant group. The median maximum diameter test results exhibited abnormal outliers in both groups, attributed to the large sample sizes (176 and 27 respectively), yielding statistically significant intergroup differences (U=3416.0000, P\u0026lt;0.01*).In the malignant group, pancreatic lesions were distributed as follows: 46.02% in the head and neck region and 53.98% in the body and tail region. In the non-malignant group, 70.37% of lesions were located in the head and neck region and 29.63% in the body and tail region. The difference in lesion distribution between groups was statistically significant (\u0026chi;\u0026sup2;=6.3677, P=0.0116). See Table 4 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Characteristics of the Patients\u0026apos; Ultrasonographic Endoscopic Profiles\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003eNon-malignant (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eMalignant (n=176)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMaximum Diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e25.30 (20.55, 33.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e35.70 (28.18, 43.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003eU = 3416.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eStrain Ratio (SR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e20.00 (14.62, 27.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e27.05 (20.25, 44.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003eU = 3024.5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0226*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eLesion Location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 6.3677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0116*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eHead/Neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e19 (70.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e81 (46.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eBody/Tail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e8 (29.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e95 (53.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eElastography Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e2 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e25 (92.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e176 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eContrast Enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0207*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNon-enhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e3 (11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e16 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eIsoenhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1 (3.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6 (3.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003eHypoenhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 164px;\"\u003e\n \u003cp\u003e20 (74.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e141 (80.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHyperenhancement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3 (11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13 (7.39%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Note: \u003cem\u003eU\u003c/em\u003e: Mann-Whitney U test, \u0026chi;\u0026sup2;: Chi-square test, -: Fisher\u0026apos;s exact test, \u003cem\u003e*P\u003c/em\u003e\u0026lt;0.05 indicates statistically significant difference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Value of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEUS-E\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCE-EUS,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Their Combination for Pancreatic Solid Lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEUS-E defined pancreatic malignancy as an elastography score \u0026ge;3. Calculating elastography scores yielded an accuracy of 0.88 for distinguishing benign from malignant pancreatic solid lesions, with a sensitivity of 1.00, specificity of 0.07, positive predictive value of 0.88, and negative predictive value of 1.00.with an AUC (95% CI) of 0.56 (0.41\u0026ndash;0.68).The semi-quantitative analysis of EUS-E strain rate ratio revealed a median SR of 18.80 in the non-malignant group and 27.48 in the malignant group. The SR for non-malignant lesions was significantly lower than that for malignant lesions (P＜0.01). At the maximum Jorden index\u0026nbsp;(0.37),the optimal cutoff value was 22.07, yielding an accuracy of 0.69 for distinguishing benign from malignant pancreatic solid lesions. Sensitivity was 0.69, specificity 0.68, positive predictive value 0.94, negative predictive value 0.23, and\u0026nbsp;AUC (95% CI) 0.69 (0.57\u0026ndash;0.81).CE-EUS\u0026nbsp;defined low and high enhancement as indicators of pancreatic malignancy. The accuracy of the enhancement pattern in distinguishing benign from malignant pancreatic solid lesions was\u0026nbsp;0.81,with\u0026nbsp;a\u0026nbsp;sensitivity of 0.90,\u0026nbsp;specificity of 0.19, positive predictive\u0026nbsp;value of 0.88, negative predictive\u0026nbsp;value of 0.23,\u0026nbsp;and AUC (95% CI) of 0.56 (0.43\u0026ndash;0.70).\u0026nbsp;The combined group, where both\u0026nbsp;EUS-E\u0026nbsp;and\u0026nbsp;CE-EUS\u0026nbsp;simultaneously diagnosed malignancy, was considered malignant based on\u0026nbsp;SPLs\u0026nbsp;results.The combined group\u0026apos;s diagnostic accuracy\u0026nbsp;for distinguishing benign from malignant SPLs was calculated as follows: accuracy\u0026nbsp;0.81,\u0026nbsp;sensitivity 0.90,\u0026nbsp;specificity 0.22,\u0026nbsp;positive predictive value 0.88, negative\u0026nbsp;predictive value 0.26, AUC (95% CI) 0.58 (0.45\u0026ndash;0.72).\u0026nbsp;See Table 5\u0026nbsp;and\u0026nbsp;Figure 3\u0026nbsp;for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Diagnostic Efficacy of EUS-E, CE-EUS and Combination for Solid Pancreatic Occupations\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;Sensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;Specificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Predictive Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;Negative Predictive Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;Accuracy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;Area Under the Curve\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;EUS-E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.56 (0.41\u0026ndash;0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;CE-EUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.56 (0.43\u0026ndash;0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;SR \u0026gt; 22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.69 (0.57\u0026ndash;0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;Combined\u0026nbsp;\u003c/p\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.58 (0.45\u0026ndash;0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBinary Logistic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRegression Analysis of Predictive Factors for Pancreatic Cancer Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed binary logistic regression analysis to identify predictive factors for pancreatic cancer diagnosis. Potential associated variables were initially screened via univariate logistic regression (inclusion criterion: \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.2 in univariate analysis), followed by bidirectional stepwise regression to construct a multivariate model and identify independent influencing factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed that tumour location in the body/tail (OR=3.0866, 95% CI: 1.52\u0026ndash;6.\u003cem\u003e25\u003c/em\u003e, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01), maximum diameter (OR=1.0656, 95% CI: 1.03\u0026ndash;1.\u003cem\u003e10\u003c/em\u003e,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.01), and the CE-EUS group (OR=0.5381,95% CI: 0.34\u0026ndash;0.86, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01), and the combined group (OR = 1.9950, 95% CI: 0.67\u0026ndash;5.91, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01) were significantly associated with pancreatic cancer.The EUS-E group exhibited an abnormal outlier, likely due to the presence of zero values in the sample size, rendering the result unreliable. Additionally, a history of tumour disease (OR=0.2566, 95% CI: 0.08\u0026ndash;0.84, P=0.0245) showed statistical significance, suggesting a potential confounding effect of tumour history.Other variables, including gender, age, strain rate, BMI, history of diabetes, and smoking status, showed no significant association with pancreatic cancer (all \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). See Table 6 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 Results of One-way Logistic Regression Analysis for the Diagnosis of Pancreatic\u003c/strong\u003e \u003cstrong\u003eCancer\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eStrain Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0.9972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.98-1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.0923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.55-2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.79\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.0297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.99-1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.07\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.0155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.92-1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.77\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDiabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.2723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.52-3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.59\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eTumor History\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0.2566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.08-0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.0245\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSmoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0.9447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.48-1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.86\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLesion Location\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e3.0866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1.52-6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003eg,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMaximum Diameter\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.0656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1.03~1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003eh,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEUS-E\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e10960000000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.00~Inf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003ei,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCE-EUS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0.5381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.34-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003ej,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCombination\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0.67-5.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003ek,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: a Compared with females; b Compared with those under 50 years old; c Compared with BMI \u0026lt; 18.5; d Compared with non-diabetics; \u0026nbsp; e compared with no history of malignancy; f compared with non-smokers; g compared with head and neck region; h compared with \u0026lt;20 mm; i compared with EUS-E \u0026nbsp; negative as control; j with CE-EUS negative as control; k with combined diagnosis negative as control; \u003cem\u003e*P\u003c/em\u003e\u0026lt;0.05, statistically significant difference significance.\u003c/p\u003e\n\u003cp\u003eMultivariate analysis via bidirectional stepwise regression identified age (OR=2.71, 95% CI: 1.13\u0026ndash;6.52, P=0.03), tumour location in the body/tail (OR=0.23, 95% CI: 0.10\u0026ndash;0.51, P\u0026lt;0.01 \u003csup\u003ec,*\u003c/sup\u003e), combined group (OR=2.68,95% CI: 1.21\u0026ndash;5.\u003cem\u003e95\u003c/em\u003e, \u003cem\u003eP=0.02\u003c/em\u003e) emerged as risk factors, indicating diagnostic stability for pancreatic cancer after controlling for other variables. BMI grouping did not reach significance in the multivariate model. See Table 7 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7 Results of Multifactorial Logistic Regression Analysis for the Diagnosis of Pancreatic Cancer\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e1.13~6.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.03\u003csup\u003ea,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e0.92~5.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.08\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003eLesion Location\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e0.10~0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003csup\u003ec,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCombination Diagnosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e1.21~5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.02\u003csup\u003ec,*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: a Compared with those aged under 50; b Compared with BMI under 18.5; c Compared with head and neck region; d Compared with negative combined diagnosis. \u003cem\u003e*P\u003c/em\u003e\u0026lt;0.05 indicates statistically significant differences.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDistinguishing benign from malignant pancreatic solid lesions remains a core clinical challenge, directly influencing treatment strategies and patient prognosis. Pancreatic cancer, the most prevalent pathological type, exhibits a global five-year survival rate of 10%, 13% in the United States, whereas China reports rates of 7.2–8.5%\u0026nbsp;\u003csup\u003e[17,18]\u003c/sup\u003e.Patients with metastatic pancreatic cancer have a median survival\u0026nbsp;of merely 3–6\u0026nbsp;months,\u0026nbsp;with\u0026nbsp;stage IV patients exhibiting a five-year survival rate as low as\u0026nbsp;1.3%\u003csup\u003e[19,20]\u003c/sup\u003e .Conventional CT\u0026nbsp;and\u0026nbsp;MRI scans\u0026nbsp;have limited capability in characterising minute lesions, while\u0026nbsp;EUS-FNA\u0026nbsp;is an invasive procedure with limitations such as technical barriers and sampling errors\u0026nbsp;\u003csup\u003e[21]\u003c/sup\u003e, and some patients cannot tolerate the examination.Prior to definitive diagnosis, patients with pancreatic masses often require prolonged, repeated imaging examinations and even multiple biopsies. This not only increases financial burden but also prolongs diagnostic delays, hindering timely intervention. Consequently, exploring methods to achieve definitive diagnosis in a single examination holds significant importance for improving patient care, reducing economic strain, and enhancing prognosis.Against this backdrop,\u0026nbsp;EUS-E\u0026nbsp;and\u0026nbsp;CE-EUS\u0026nbsp;offer novel approaches to addressing early pancreatic lesion diagnosis by leveraging complementary tissue mechanical properties and blood flow perfusion characteristics.\u003c/p\u003e\n\u003cp\u003eEUS-E distinguishes benign from malignant lesions by assessing tissue hardness variations, finding extensive application in diagnosing various conditions. It demonstrates particularly high accuracy in differentiating benign from malignant lesions in the pancreas and lymph nodes\u003csup\u003e[22–24]\u003c/sup\u003e.This study demonstrates that the diagnostic sensitivity of the elastography score for malignant pancreatic lesions reaches 100%, with a negative predictive value of 1.00. This implies that an EUS-elastography score \u0026lt;3 points virtually excludes malignancy.This aligns with a meta-analysis of 19 studies involving 1,687 patients, which reported a sensitivity of 0.98 for EUS-E in diagnosing malignant pancreatic masses\u003csup\u003e[25]\u003c/sup\u003e. Other studies have similarly demonstrated that elasticity-guided EUS-FNA achieves 100% sensitivity for detecting malignant pancreatic lesions\u0026nbsp;\u003csup\u003e[26]\u003c/sup\u003e.The high sensitivity of EUS elastography indicates its exceptional reliability in ruling out malignant tumours, particularly crucial for screening highly malignant tumours such as pancreatic cancer\u003csup\u003e[27]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eConsidering the limitations of qualitative scoring, namely its high subjectivity and difficulty in standardisation, this study further introduced SR as a semi-quantitative indicator. Results showed that the median SR for malignant lesions was 27.48, significantly higher than the median SR of 18.80 for non-malignant lesions (P \u0026lt; 0.01).The optimal SR cutoff value was 22.27, yielding 69% diagnostic accuracy and an AUC of 0.69, indicating its auxiliary value in distinguishing pancreatic lesion characteristics.Although optimal SR cut-off values for diagnosing pancreatic malignancy vary across studies, the overall trend indicates that higher SR values correlate with increased malignant risk in pancreatic lesions\u003csup\u003e[28–31]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIt is evident that EUS-E possesses inherent limitations. Its 19% specificity suggests it may misclassify non-malignant lesions (such as mass-type pancreatitis or fibrotic foci) as malignant, thereby increasing the rate of misdiagnosis in clinical practice.Previous studies have indicated that the elastic characteristics of nodular pancreatitis and pancreatic neuroendocrine tumours may overlap with those of pancreatic ductal adenocarcinoma, leading to false-positive results. Furthermore, pancreatic fibrosis increases tissue stiffness, thereby interfering with the ability of elastography to distinguish between benign and malignant lesions\u003csup\u003e[29,32]\u003c/sup\u003e.The higher sensitivity observed in this study may relate to the exceptionally high proportion of malignant tumours\u0026nbsp;(86.70%)\u0026nbsp;among included cases and operator expertise. Moreover, the accuracy of elastography findings is influenced by multiple factors, including operator experience and technical proficiency, lesion location, and size, with such variations potentially contributing to inconsistent results\u003csup\u003e[29,33]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCE-EUS, utilising intravenous microbubble contrast agents to visualise real-time blood flow perfusion patterns, serves as a crucial tool for assessing tumour vascularity\u003csup\u003e[34]\u003c/sup\u003e. Unlike EUS-E, which focuses on stiffness, CE-EUS employs second-generation contrast agents to observe microvascular distribution in real-time under EUS guidance, aiding in the identification of typical features in pancreatic cancer such as low enhancement and avascularity.Studies indicate that pancreatic cancer predominantly exhibits a hypoenhancement pattern, whereas neuroendocrine tumours often show hyperenhancement, and inflammatory lesions may present with isointense or hyperintense enhancement\u0026nbsp;\u003csup\u003e26,34–37\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMultiple studies demonstrate that the low-enhancement pattern defined by CE-EUS holds significant diagnostic value for differentiating SPLs from pancreatic malignancies\u003csup\u003e[39–43]\u003c/sup\u003e.\u0026nbsp;Two meta-analyses (n=2807) reported pooled sensitivity and specificity of CE-EUS for SPL differentiation at 93%–94% and 88%-89%, respectively\u003csup\u003e[44,45]\u003c/sup\u003e.\u0026nbsp;In the present study, CE-EUS demonstrated high\u0026nbsp;sensitivity\u0026nbsp;in distinguishing benign from malignant SPLs, with enhancement patterns closely correlated to lesion malignancy and histopathological type.Pancreatic cancer predominantly exhibits low enhancement, reflecting its characteristic pathologic features of avascularity, uneven perfusion, and reduced microvascular density. Non-malignant lesions predominantly show isointense enhancement, with some demonstrating no enhancement, suggesting local necrosis or inflammatory congestion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven the considerable variability in histology and haemoperfusion among pancreatic solid lesions, a single imaging modality often fails to comprehensively capture all lesion characteristics.EUS-E focuses on tissue stiffness, while CE-EUS provides vascular information. Their combination enables a dual-dimensional assessment of structure and function, compensating for the limitations of individual techniques. Multiple studies have demonstrated that this combination effectively enhances diagnostic performance\u003csup\u003e[45–48]\u003c/sup\u003e. However, these studies suffer from small sample sizes and high heterogeneity, resulting in limited comparability of findings.\u003c/p\u003e\n\u003cp\u003eThis prospective study prospectively enrolled 203 patients with SPLs. Pancreatic lesions were classified as malignant when the EUS-E score was ≥3 and CE-EUS demonstrated low or high enhancement; all other patients were defined as non-malignant based on combined diagnosis.Results demonstrated that the combined application of EUS-E and CE-EUS achieved an accuracy of 88%, sensitivity of 90%, specificity of 22%, positive predictive value (PPV) of 88%, and negative predictive value (NPV) of 26% in distinguishing pancreatic solid lesions.demonstrating superior overall diagnostic performance compared to individual modalities. The AUC reached 0.58, indicating high clinical utility for this combined approach in distinguishing benign from malignant pancreatic solid lesions.This aligns with findings from Shin et al.'s meta-analysis, which reported combined sensitivity of 84% and specificity of 85% for EUS-E and CE-EUS\u003csup\u003e[49]\u003c/sup\u003e, further validating the reliability and universality of this combined strategy.Although the specificity was relatively low, it can still help identify false-positive results. Some people with malignant tumors may have been misdiagnosed as having benign tumors. However, the PPV is 88%, which indicates that the test's positive results are very accurate. This can provide reliable evidence for surgical decisions.Moreover, multivariate logistic regression analysis indicated that combined diagnostic results constitute an independent risk factor for pancreatic cancer (OR=2.68, 95% CI: 1.21–5.\u003cem\u003e95\u003c/em\u003e,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01).\u0026nbsp;This demonstrates the model's stable independent predictive power after controlling for other variables, further supporting the application potential of combined diagnosis in early pancreatic cancer screening and clinical decision-making.\u003c/p\u003e\n\u003cp\u003eInnovation and strengths of this study: This study innovatively combined EUS-E and CE-EUS to assess the benignity or malignancy of SPLs, addressing the limitations of previous single-technique studies.Accuracy and reliability were ensured by establishing standardised combined diagnostic thresholds (EUS-E score ≥ 3 and CE-EUS showing low/high enhancement) against pathology or long-term follow-up as the gold standard. Furthermore, its prospective design and standardised data collection enhanced scientific rigour.However, this study has certain limitations.: single-centre origin may introduce selection bias, affecting generalisability; relatively few benign lesions may impact assessment of specificity and other metrics; and image interpretation remains subjective, lacking uniform quantitative standards.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective observational study was approved by the Ethics Committee of Guizhou Medical University Cancer Hospital (Ethics Approval Number: SL-202104092), all patients have signed informed consent, and all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is supported by Guizhou Provincial Science and Technology Foundation (Grant Number: gzwkj2024-080), Guizhou Clinical Research Center for Digestive Diseases [grant no. Qian Ke He Platform-LCZX (2025) 001].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available due to including personal medical and life information. But the datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, P.L., Z.L. and W.Z.; methodology, P.L., T.D. and Z.L.; writing—original draft preparation, C.X.Z., R.X.S. and T.T.H.; writing—review and editing, W.Z., and Q.L.; supervision, W.Z. and Z.L ; funding acquisition, W.Z. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDietrich CF, Hocke M. 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The efficiency of contrast-enhanced endoscopic ultrasound (EUS) combined with EUS elastography for pancreatic cancer diagnosis: a systematic review and meta-analysis. \u003cem\u003eUltrasonography\u003c/em\u003e. 2023;42(1):20-30. doi:10.14366/usg.22103\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pancreatic solid lesions, endoscopic ultrasound elastography, contrast-enhanced endoscopic ultrasound, combined diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-9395390/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9395390/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo evaluate the diagnostic efficacy of endoscopic ultrasound elastography (EUS-E), contrast-enhanced endoscopic ultrasound (CE-EUS), and their combined application in distinguishing benign from malignant solid pancreatic lesions (SPLs), thereby providing evidence for precise clinical diagnosis and individualised treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e.\u003cstrong\u003e \u003c/strong\u003eThis study is a single-center, prospective study. Patients who were diagnosed with pancreatic lesions and underwent EUS-E and CE-EUS examinations at the Endoscopy Center of the Guiyang Medical University Affiliated Tumor Hospital from September 2022 to December 2025 were included. Patients were divided into malignant and non-malignant groups based on the results of the pathological examination, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), or at least six months of follow-up. The differences in clinical characteristics and imaging indicators between the two groups were compared.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThis study included 203 patients with solid pancreatic lesions (176 malignant, 27 non-malignant). The combined diagnostic approach of EUS-E and CE-EUS (elasticity score ≥3 points and CE-EUS showing low/high enhancement) demonstrated excellent efficacy: sensitivity 0.90, specificity 0.22, accuracy 0.81,with an AUC of 0.58 (95% CI: 0.445–0.72), indicating that the combined diagnostic strategy significantly enhances the ability to distinguish between benign and malignant pancreatic lesions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eEUS-E demonstrates high sensitivity, aiding in the early detection of malignant lesions, but its low specificity carries a risk of misdiagnosis.CE-EUS exhibits strong specificity and excels in identifying perfusion abnormalities, though it may overlook certain hypoperfused lesions. The combined application of EUS-E and CE-EUS markedly improves diagnostic balance, achieving high sensitivity and specificity with an AUC of 0.58, surpassing either modality alone.\u003c/p\u003e","manuscriptTitle":"Diagnostic Value of Combined Endoscopic Ultrasound Elastography and Contrast-Enhanced Ultrasound in Solid Pancreatic Lesions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 13:26:37","doi":"10.21203/rs.3.rs-9395390/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"2906642650768228040917646644487594420","date":"2026-05-07T12:24:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T06:13:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-15T07:44:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T04:18:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T04:17:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-04-12T15:30:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd97a901-1041-455c-a0fb-9c0d05e6e49b","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"2906642650768228040917646644487594420","date":"2026-05-07T12:24:04+00:00","index":40,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-06T06:13:14+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T13:26:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 13:26:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9395390","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9395390","identity":"rs-9395390","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}