Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is the most common (90%) type of solid pancreatic neoplasm. Due to its late presentation and poor survival rate, early diagnosis and timely treatment is of utmost importance for better clinical outcomes. Endoscopic ultrasound provides high-resolution images of the pancreas and has excellent sensitivity in the diagnosis of even small (<2 cm) pancreatic lesions. Apart from imaging, it also has an advantage of tissue acquisition (EUS fine-needle aspiration, FNA; or fine-needle biopsy, FNB) for definitive diagnoses. EUS-guided tissue acquisition plays a crucial role in genomic and molecular studies, which in today’s era of personalized medicine, are likely to become important components of PDAC management. With the use of better needle designs and technical advancements, EUS has now become an indispensable tool in the management of PDAC. Lastly, artificial intelligence for the detection of pancreatic lesions and newer automated needles for tissue acquisition will obviate observer dependency in the near future, resulting in the wider dissemination and adoption of this technology for improved outcomes in patients with PDAC.

Basic Principles and Role of Endoscopic Ultrasound in Diagnosis and Differentiation of Pancreatic Cancer from Other Pancreatic Lesions: A Comprehensive Review of Endoscopic Ultrasound for Pancreatic Cancer

“…Figure 2 shows the features of intraductal papillary mucinous neoplasm, and Figure 3 shows the morphological features of some of the pancreatic lesions in EUS [35,36]. The characteristic features of various commonly encountered pathologies in EUS are discussed in Table 2 [37][38][39][40][41][42][43]. Table 2.…”

“…Pancreatic Adenocarcinoma [26,42,43] Heterogenous, hypoechoic mass with an irregular border High Variable…”

Comparative Assessment of Endoscopic Ultrasound-Guided Biopsies vs. Percutaneous Biopsies of Pancreatic Lesions: A Systematic Review and Meta-Analysis of Diagnostic Performance

“…The intervention is performed under deep sedation. Afterward, the tissue is taken, which can be conducted through fine needle aspiration (FNA), usually using 19–25-gauge caliber needles [ 26 , 27 , 28 ]. These techniques allow for better visualization and approximation of the tissue under examination, as compared with CT- or US-guided biopsies.…”