ABSTRACT Background and Aims Contrast‐enhanced endoscopic ultrasonography (CE‐EUS) provides clearer visualization of wall layer structures in gallbladder nodules than B‐mode EUS. This study aimed to compare the diagnostic performance of B‐mode EUS and CE‐EUS in differentiating benign from malignant gallbladder lesions. Methods Patients who underwent both B‐mode EUS and CE‐EUS for gallbladder nodules with available pathological diagnoses were retrospectively analyzed. The diagnostic findings of each modality were evaluated by univariate and multivariate analyses. Results Eighty‐six patients were included (31 malignant, 55 benign). On B‐mode EUS, a pedunculated shape and presence of a Rokitansky–Aschoff sinus were associated with benignity, whereas diameter ≥ 20 mm and an unclear or disrupted wall layer structure were associated with malignancy. On CE‐EUS, unclear or disrupted wall layer structure was strongly associated with malignancy, whereas enhancement patterns showed only univariate significance. Multivariate analysis identified unclear or disrupted wall layer structure on CE‐EUS and diameter ≥ 20 mm as independent predictors of malignancy. Diagnostic accuracy was significantly higher with CE‐EUS evaluation of wall layer structure (93%) than with B‐mode EUS evaluation of maximum diameter (78%, p < 0.001). Conclusion CE‐EUS, particularly assessment of wall layer structure, improves differentiation between benign and malignant gallbladder nodules and complements B‐mode EUS.
Yoshida et al. (Fri,) studied this question.