EUS and Solid Pancreatic Lesions

Endoscopic ultrasound (EUS) is a well established tool for the evaluation of focal pancreatic lesions. Due to the proximity of the echoendoscope to the pancreas, it offers high resolution images and therefore a high sensitivity for detection of even small pancreatic masses (<3 cm), undetectable by other imaging techniques. EUS-guided fine needle aspiration (FNA) and biopsy (FNB) are the preferred modalities for obtaining tissue from solid pancreatic masses and may help establish tissue diagnosis with high accuracy and low complication rates. Ancillary techniques, such as contrast-enhanced EUS and EUS elastography, provide additional details potentially helping select patients who would benefit most from EUS-guided sampling, thus leading to more accurate diagnosis. Staging as well as assessment of resectability of patients with pancreatic cancer is challenging and EUS may be useful in cases with inconclusive computed tomography (CT) scans, particularly regarding the assessment of vascular invasion. Last, EUS holds promise as a method enabling treatment of locally advanced and borderline pancreatic cancer mainly by providing access to the tumor for targeted therapies.