{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:11:37Z","timestamp":1789517497040,"version":"build-2803163510"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020668","name":"European Research Executive Agency","doi-asserted-by":"crossref","award":["101079210\/2022"],"award-info":[{"award-number":["101079210\/2022"]}],"id":[{"id":"10.13039\/100020668","id-type":"DOI","asserted-by":"crossref"}]},{"award":["101079210\/2022"],"award-info":[{"award-number":["101079210\/2022"]}],"id":[{"id":"https:\/\/ror.org\/05mkt9r11","id-type":"ROR","asserted-by":"publisher"}]},{"name":"UEFISCDI, Ministry of Education, Romania","award":["23PHE\u20442023"],"award-info":[{"award-number":["23PHE\u20442023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Contrast-enhanced harmonic imaging endoscopic ultrasound (CHI-EUS) is a valuable tool for characterizing solid pancreatic tumors. However, interobserver variability remains a significant limitation in clinical interpretation. Artificial intelligence (AI) may offer objective, reproducible assessments, potentially enhancing diagnostic performance. This study compared the diagnostic accuracy and interobserver agreement of nine physicians with varying CHI-EUS experience levels vs. a dedicated AI system and a general-purpose large language model (ChatGPT) on the same 118 histologically confirmed cases. Methods: We conducted a prospective, multicenter, observer-blinded study involving 118 CHI-EUS video cases of histologically confirmed (EUS-FNB) focal pancreatic masses from three tertiary care centers in Romania. Nine readers were stratified into three groups: trainees (&lt;5 years CHI-EUS experience), intermediates (5\u201310 years), and experts (&gt;10 years). All readers and two AI models received standardized, anonymized 2 min CHI-EUS video clips. A dedicated AI system used a convolutional neural network (CNN) for lesion segmentation and time\u2013intensity curve (TIC) extraction, followed by a feedforward neural network (FNN) for classification. ChatGPT was separately evaluated on the same videos. Diagnostic metrics (accuracy, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and AUROC) were calculated. Interobserver agreement was assessed using Fleiss\u2019 and Cohen\u2019s kappa statistics. Results: The dedicated AI system achieved an overall accuracy of 95.8% (sensitivity 96.6%; specificity 94.1%) in diagnosing pancreatic adenocarcinoma. Expert readers had a mean accuracy of 78.8% (sensitivity 86%, specificity 61%, and AUROC 0.74), intermediates 80.8% (sensitivity 83%, specificity 75%, and AUROC 0.84), and trainees had a mean accuracy of 67.2% (sensitivity 70%, specificity 60%, and AUROC 0.67). For the most-likely-diagnosis parameter, interobserver agreement was similar between intermediates (Fleiss\u2019 \u03ba = 0.407) and experts (\u03ba = 0.389), while trainees showed lower agreement (\u03ba = 0.203). ChatGPT correctly classified only 14.1% of PDAC cases. Conclusions: A specialized AI model for CHI-EUS video analysis can achieve expert-level performance and reduce diagnostic variability across experience levels. Integration of dedicated AI systems into CHI-EUS interpretation may enhance accuracy and serve as a valuable decision support tool in clinical and training settings.<\/jats:p>","DOI":"10.3390\/jcm15093556","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:03:37Z","timestamp":1778144617000},"page":"3556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Artificial Intelligence vs. Human Readers in Contrast-Enhanced Harmonic Imaging Endoscopic Ultrasound Interpretation of Solid Pancreatic Masses: A Multicenter Interobserver Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Nicoleta","family":"Podin\u0103","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4526-0864","authenticated-orcid":false,"given":"Lucian Gheorghe","family":"Gruionu","sequence":"additional","affiliation":[{"name":"Faculty of Automation, Computers and Electronics, University of Craiova, 200585 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5560-6435","authenticated-orcid":false,"given":"Anca","family":"Udri\u0219toiu","sequence":"additional","affiliation":[{"name":"Faculty of Mechanics, University of Craiova, 200585 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2031-5316","authenticated-orcid":false,"given":"Elena Codru\u021ba","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Voicu","family":"Rednic","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1791-5728","authenticated-orcid":false,"given":"Alina Liliana","family":"Constantin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Simona","family":"Badiu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5348-0341","authenticated-orcid":false,"given":"Cristian George","family":"\u021aieranu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7531-6075","authenticated-orcid":false,"given":"Nona","family":"Bejinariu","sequence":"additional","affiliation":[{"name":"Santomar OncoDiagnostics, Regina Maria, 400000 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9881-4114","authenticated-orcid":false,"given":"Cristina","family":"Pojoga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"},{"name":"Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Babe\u0219-Bolyai University, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9197-5249","authenticated-orcid":false,"given":"Claudia","family":"Hagiu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5809-1334","authenticated-orcid":false,"given":"Andrada","family":"Seicean","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"S\u0103ftoiu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1055\/s-2007-1010273","article-title":"Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma","volume":"25","author":"Palazzo","year":"1993","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.gie.2005.06.051","article-title":"Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis","volume":"62","author":"Varadarajulu","year":"2005","journal-title":"Gastrointest. 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Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3556\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:48:37Z","timestamp":1778561317000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093556"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093556","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]}}}