Search Results (73)

Background and Clinical Significance: Pancreatic neuroendocrine tumors (pNETs) rarely exhibit intraductal growth, a pattern that may mimic intraductal papillary mucinous neoplasms (IPMNs) or pancreatic ductal adenocarcinoma (PDAC). Preoperative recognition is challenging, particularly when associated with anatomic variants such as pancreas divisum. Case Presentation: A 63-year-old man with a history of pancreatic duct dilation presented with pruritus, weight loss, and lymphadenopathy. Cross-sectional imaging revealed a cephalopancreatic mass with upstream ductal dilatation. EUS demonstrated a hypervascular lesion with intraductal extension into the dorsal duct in the setting of pancreas divisum. EUS-FNB confirmed a well-differentiated pNET (G1) with loss of DAXX expression and preserved ATRX. Ga-68 PET/CT showed intense uptake in the primary lesion and lower-grade uptake in two additional nodules, later proven non-neoplastic. A multidisciplinary tumor board recommended preoperative optimization with somatostatin analog therapy and supervised weight reduction, followed by pylorus-preserving duodenocephalopancreatectomy. Final pathology confirmed NET G1 with intraductal growth and full concordance with preoperative EUS-FNB findings. Conclusions: in this case, a pNET showed intraductal growth within the dorsal duct in the context of pancreas divisus, further expanding the range of its reported presentations. It underscores the diagnostic value of EUS-FNB for morphologic, proliferative, and molecular characterization, and highlights the importance of multidisciplinary evaluation in guiding preoperative optimization and tailored surgical management. Full article

Background: Serous cystic neoplasm (SCN) is a common benign pancreatic lesion frequently encountered in practice. However, diagnostic confirmation by Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is often limited by inadequate tissue acquisition. Fine-needle biopsy (FNB) has been increasingly performed. We aimed to compare the diagnostic yield of SCN using FNB and FNA needles and to identify factors associated with successful diagnosis. Methods: We retrospectively analyzed 77 patients with pancreatic lesions suspected to be SCN who underwent either EUS-FNB (n = 47 procedures) or EUS-FNA (n = 50 procedures). The primary outcome was diagnostic yield. Secondary outcomes included predictors of diagnostic yield, which were evaluated using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) analyses were performed to identify the optimal biopsy strategy. Results: Diagnostic yield was significantly higher with EUS-FNB than with EUS-FNA (44.68% vs. 14.00%; OR 4.96, 95% CI 1.85–13.28, p < 0.01). From univariate and multivariate analysis, larger cyst size, use of the Franseen FNB needle, and a higher number of needle passes were independent factors associated with diagnostic yield. ROC analysis showed modest discrimination for cyst size (AUC 0.69), with an optimal cutoff of ≥17 mm (sensitivity 87.50%, specificity 41.51%). Conclusions: EUS-FNB provided superior diagnostic yield compared with EUS-FNA for pancreatic SCN. Lesion size, use of a Franseen needle, and the number of needle passes are key factors associated with successful tissue diagnosis. Full article

Background/Objectives: Endoscopic Ultrasound with Fine Needle Biopsy (EUS-FNB) of pancreatic lesions often induces patient anxiety. Graphic medicine, an emerging health communication tool, could potentially mitigate this. This pilot study aimed to explore the feasibility of a graphic novel in reducing anxiety in adult patients awaiting EUS-FNB. Methods: This prospective, single-center, randomized pilot study was conducted from June 2024 to March 2025 in patients aged 18–89 years. The intervention group received a comic panel detailing the EUS-FNB routine, while controls had standard care. Anxiety was measured using the Beck Anxiety Inventory (BAI) and modified DASS-21 (mASS-14). Results: Overall, 65 patients (33 “Graphic Novel”, 32 “Control”) were included. Mean BAI was 4.88 (graphic novel) vs. 7.25 (controls, p = 0.092), and mASS-14 was 4.97 vs. 6.22 (p = 0.261). Anxiety prevalence was low (4.6% BAI, 13.8% mASS-14). Controls were more symptomatic (69.2%) and had a higher rate of pancreatic cancer (n = 20) compared to the graphic novel group (n = 6). Subgroup analyses showed that BAI was slightly lower for patients with children and no prior surgical experience when using graphic novels. Trends for lower anxiety appeared in those on chronic medication, under surveillance, or with solid/suspected metastatic lesions. Conclusions: This pilot study suggests that a graphic novel may help to reduce anxiety and stress scores in patients undergoing diagnostic procedures for pancreatic lesions. However, it needs confirmation in larger, adequately powered trials. Full article

Background/Objectives: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has become the standard for diagnosing solid pancreatic masses (SPMs). However, in the absence of rapid on-site cytopathologic evaluation (ROSE), the optimal number of needle passes remains uncertain. This study aimed to evaluate the diagnostic performance of EUS-FNB using a gross-eyed evaluation with the fanning technique in patients with pancreatic malignancy. Methods: This retrospective single-center study included 140 patients with confirmed pancreatic malignancy who underwent EUS-FNB with at least three needle passes between January 2022 and December 2025. Gross-eyed visual inspection for whitish core tissue was used to assess the specimen adequacy. The primary outcome was the diagnostic rate of malignancy. The secondary outcomes included the tissue adequacy and yield rate of malignancy. Results: The diagnostic rate of malignancy improved with additional passes, 72.1% for one pass, 82.9% for two, and 90.7% for three. However, the gain beyond two passes was marginal. The tissue adequacy was high across all passes (≥94.3%), with most samples deemed adequate within two passes. The yield rate of malignancy similarly improved from 82.1% (one pass) to 91.4% (three passes). No adverse events were reported. Gross-eyed evaluation was feasible in all cases and guided effective sampling. Conclusions: EUS-FNB with two puncture numbers and the fanning technique achieves high diagnostic performance for pancreatic malignancy without the need for ROSE and MOSE. Two passes appear sufficient in most cases, supporting a simplified and safe approach that minimizes unnecessary needle passes. Full article

Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer, accounting for approximately 75–80% of all renal carcinomas, and is often diagnosed incidentally on abdominal imaging, such as abdominal ultrasound or CT scan. Among other types of renal cancer, ccRCC is recognized to be highly aggressive due to its metastatic potential, which leads to a poor prognosis and an increased mortality rate. The most common sites of ccRCC metastasis are the lung, lymph nodes, bone, liver, and adrenal glands. Clear cell RCC is the most frequent primary tumor associated with secondary pancreatic involvement, while overall, pancreatic metastases represent only 2–5% of all malignant pancreatic lesions. These metastases often occur many years after nephrectomy and may present as solitary or oligometastatic disease, frequently displaying a paradoxically favorable prognosis compared with other metastatic sites. The present narrative review we conducted emerged from presentations of ccRCC with pancreatic distant metastases, potentially labeled as primary pancreatic tumors on imaging studies, mimicking pancreatic neuroendocrine tumors due to the hypervascular nature of ccRCC. Four patients were investigated in our clinic for suspicious pancreatic lesions identified on CT imaging, involving both the head and body of the pancreas. The definitive diagnosis was established by performing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or fine-needle biopsy (FNB) and histopathological analysis of the collected tissue samples. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has emerged as a pivotal tool for obtaining tissue diagnosis, particularly when cross-sectional imaging is inconclusive. Through a synthesis of clinical data and literature, this article underscores the essential diagnostic role of EUS-guided tissue acquisition and its impact on therapeutic decision-making. Full article

Endoscopic ultrasound (EUS) with fine-needle biopsy (FNB) is one of the techniques applied for sampling subepithelial lesions (SELs) of the gastrointestinal tract. Elastography and contrast-enhanced evaluation could permit identification of different patterns among areas of the lesions, depending on their consistence and the presence of vital cells or necrosis. Targeting a specific area when performing FNB in the case of large lesions could potentially permit an increase in accuracy and reduce the need for re-sampling. A 61-year-old woman was admitted reporting severe abdominal pain. The patient underwent cholecystectomy many years ago. She had no known family history of gastrointestinal, hepatic, biliary, or pancreatic disease. Laboratory tests were normal. A computed tomography scan showed a large lesion between the stomach and the pancreatic body, suspected to originate from the gastric wall. An endoscopic view showed a large bulging into the gastric lumen and EUS identified a lesion originating from the muscular layer of the gastric wall. Elastography and contrast-enhanced EUS identified two different areas, one softer with lower enhancement (A) and the other harder with higher enhancement after contrast injection (B). FNB was performed targeting both the areas, sending samples for separate histological evaluation. Histology showed a gastrointestinal stromal tumor (GIST), finding differences in amount of necrotic and neoplastic cells between the two areas. EUS-FNB guided by elastography and/or contrast-enhanced EUS could identify differences within large SELs, allowing targeting of areas more likely to collect diagnostic samples. Full article

Esophageal squamous cell carcinoma (ESCC) is the most prevalent histological subtype of esophageal cancer worldwide, typically manifesting as an endoluminal mass with overt mucosal involvement. Exceptionally, however, ESCC may present with an intramural growth pattern beneath an apparently intact mucosal surface, a presentation that is exceedingly rare and prone to misdiagnosis. In such cases, repeated endoscopic biopsies are frequently non-diagnostic, thereby delaying appropriate management. Endoscopic ultrasound (EUS) has emerged as the cornerstone for detecting and characterizing intramural lesions, enabling assessment of tumor infiltration depth and nodal status, while complementary imaging with CT and PET contributes to accurate staging. To date, only a handful of intramural ESCC cases have been described, and their clinical, endoscopic, and radiological features remain poorly delineated. This review appraises the existing literature on primary intramural ESCC with intact mucosa, with the dual aims of summarizing the diagnostic challenges and highlighting the value of a multimodal approach to avoid unnecessary surgical interventions. Furthermore, we report an additional case from our experience, which underscores the critical role of EUS and integrated imaging in achieving timely and accurate diagnosis of this unusual entity. Full article

Background and Aims: Solid pseudopapillary neoplasms (SPN) are rare neoplasms of the pancreatic gland. Despite the indolent behavior, surgical resection is required according to the risk of metastasis development. Few data are available on endoscopic ultrasound (EUS) features, comparison between the features described at EUS and contrast-enhanced, and diagnostic accuracy and safety of EUS-guided FNB in these tumors. Patients and Methods: All consecutive patients with a EUS-guided FNB-based pathological diagnosis of SPN were extrapolated from a prospectively maintained database. Demographic, radiologic, and echo-endoscopic features were collected. FNB specimens were re-evaluated from two expert pathologist and the main histological features of SPN were investigated. Results: Thirty-seven patients were included (32 females and 5 males), with a mean age of 35.8 ± 15.8 years. Contrast-enhanced imaging based diagnosis was accurate in 20 patients (54.1%). EUS features were significantly different compared to contrast-enhanced imaging in terms of cystic appearance (40.5% vs. 16.2%; p = 0.03) and vascular pattern (p = 0.01). FNB-based diagnosis of SPN was confirmed on surgical specimen in all, 37 patients, resulting in a diagnostic accuracy of EUS-guided FNB of 100%. Only one patient (2.6%) experienced a mild procedure-related adverse event. Discussion: Contrast-enhanced imaging based diagnosis of SPN is difficult. Despite the rarity of the disease, EUS-guided FNB with 22-gauge fork-tip needle has a very high diagnostic accuracy for SPN, with rare and mild adverse events. Full article

Introduction: A new core biopsy needle with a novel tapered stylet tip has been introduced for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). The tapered point stylet is purported to improve ease of puncture, leading to improved tissue acquisition and accuracy. However, there are no data available in the published literature. The aim of this study was to compare the diagnostic performance of the tapered stylet needle with conventional end-cutting FNB needles for tissue acquisition from solid lesions. Methods: Patients who underwent EUS-FNB of a solid lesion using the tapered stylet FNB needle across four tertiary hepatopancreaticobiliary centres in the UK were included in the study. Demographic, clinical, and performance outcomes were included in the analysis. Diagnostic performance was compared with a similar cohort of patients who underwent EUS-FNB using standard end-cutting FNB needles with a blunt-tipped stylet. The primary outcome was accuracy for the diagnosis of malignancy. Results: A total of 270 patients were included for analysis; 129 patients (48%) had sampling with the novel tapered stylet tip needle, among which 50% were female, the median age was 69, 74% had pancreatic lesions, and 80% had a final diagnosis of malignancy; 141 control cases (52%) were included for comparison, among which 48% were female, the median age was 68, 67% had pancreatic lesions, and 72% had a final diagnosis of malignancy. The tapered stylet needle demonstrated a sensitivity of 90% and an NPV of 72% for the diagnosis of malignancy compared with 88% and 77% for controls (p = 0.147). The overall diagnostic accuracy of the tapered stylet needle was 92.2% compared with 91.5% for controls (p = 0.634). Conclusions: The novel tapered tip stylet FNB needle demonstrated comparable sensitivity, NPV, and diagnostic accuracy to conventional FNB needles. This is the first and largest study reporting results for this new needle. However, further large comparative studies are warranted to validate our results and to determine if the tapered stylet offers an advantage over the conventional design. Full article

Background and Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy (FNB) is the standard method for diagnosing abdominal masses, but sample inadequacy and diagnostic accuracy remain challenges. Conventional smear (CS) and liquid-based cytology (LBC) are standard processing methods, yet their comparative effectiveness and potential combined benefit remain unclear. We performed a systematic review and meta-analysis to evaluate and compare the diagnostic performance and adequacy of CS, LBC, and their combination. Methods: A systematic search was conducted in Medline, Embase, and CENTRAL on 17 November 2024. Studies comparing CS, LBC, or their combination following EUS-FNA/FNB for abdominal masses were included. Diagnostic parameters, including sensitivity, specificity, accuracy, and inadequacy rates, were extracted and analyzed. Methodological quality was assessed using QUADAS-2. Results: 16 studies (2128 patients) were included. Sensitivity for pancreatic masses was 71.4% (CI: 62.9–78.7) for CS, 74.7% (CI: 64.3–82.8) for LBC, and 86.2% (CI: 82.4–89.3) for combined methods (p = 0.001). For all abdominal masses, sensitivity was 76.3% (CI: 67.9–83.0) for CS, 73.6% (CI: 65.6–80.2) for LBC, and 88.0% (CI: 84.0–91.2) for combined methods (p ≤ 0.006). Specificity was nearly 100%. Inadequacy rates were lowest for combined methods (1.5%, CI: 0–36.2), when compared to LBC (7.7%, CI: 2.7–20.4) and CS (4.4%, CI: 2.4–7.9). Moderate bias risk was noted, primarily due to incorporation bias. Domain 3 (reference standard) of QUADAS was uniformly moderate-risk across studies. Conclusions: Combining CS and LBC methods improves diagnostic sensitivity and reduces sample inadequacy after EUS-guided tissue acquisition for abdominal masses, particularly pancreatic lesions. Clinical guidelines should consider recommending the combined approach to enhance diagnostic yield and clinical outcomes. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with a dismal prognosis; this is in part due to its late diagnosis at advanced stages. For many patients, medical treatment is the only practicable therapy. In recent years, the development of new technologies that investigate genomic biomarkers has improved the concept of precision medicine to treat patients with PDAC. Through endoscopic ultrasound–tissue acquisition (EUS-TA), tissue from pancreatic cancers can be collected; thus, it has the potential to advance personalized treatment by allowing the assessment of genomic alterations. In this review, we explore the role of EUS in genomic profiling and its strengths and pitfalls in obtaining samples for next-generation sequencing (NGS). Full article

Background and Objectives: Endoscopic ultrasonography (EUS)-guided fine-needle aspiration/biopsy (FNA/B) is widely used for solid pancreatic lesions; however, the optimal number of needle punctures required to achieve high diagnostic accuracy remains unclear. This study aimed to identify the ideal number of punctures required for solid pancreatic lesions using EUS-FNA/B. Methods: This single-center retrospective study included 598 patients who underwent EUS-FNA/B for solid pancreatic lesions. We analyzed the cumulative tissue acquisition rates and diagnostic accuracy rates for cytology and histology, and identified the factors associated with diagnostic accuracy using univariate and multivariate analyses. Rapid on-site cytological evaluation was performed in all cases. Results: Cumulative tissue acquisition rates were 95.6% and 92.5% for cytology and histology, respectively. The diagnostic accuracy for cytology increased from 72.6% in the first puncture to 78.8% in the second puncture (p = 0.0233). In contrast, the diagnostic accuracy of histology increased from 72.0% at the first puncture to 83.2% at the third puncture (p = 0.0412). Statistically significant differences were noted between the first and second punctures for cytology, and between the first, second, and third punctures for histology. Univariate and multivariate analyses were conducted to identify factors associated with diagnostic accuracy. In cytology, sex was identified as a significant contributing factor, whereas no independent predictors were found in histology. Conclusions: These findings suggest that two-needle punctures are optimal for cytology, and three-needle punctures are optimal for the histological diagnosis of solid pancreatic lesions using EUS-FNA/B. Full article

Background/Objectives: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a useful procedure for obtaining histological specimens. However, its utility in diagnosing autoimmune pancreatitis (AIP) has not yet been well studied. This study aimed to assess the diagnostic capability of EUS-FNB for AIP by comparing a 19-gauge Franseen needle (19FR) and a 22-gauge Franseen needle (22FR). Methods: This study included patients with a final diagnosis of AIP undergoing EUS-FNB for pancreatic lesions between January 2014 and February 2023. All patients underwent EUS-FNB with either 19FR or 22FR. Histological findings were evaluated according to the International Consensus Diagnostic Criteria (ICDC). The primary outcome was the diagnostic yield of Level 1 (≥3 ICDC items) or Level 2 (2 ICDC items). Results: The 19FR group included 31 patients, and the 22FR group included 36 patients. The Level 1 diagnostic rate was significantly higher in the 19FR group than in the 22FR group (90.3% vs. 61.1%, p = 0.010). No significant difference was observed in the Level 2 diagnostic rate. The 19FR group yielded significantly larger histological tissue samples than the 22FR group (median area: 9.19 mm²/session vs. 3.36 mm²/session, p < 0.001). The analysis demonstrated a positive correlation between tissue area and the number of histological diagnostic items obtained. Conclusions: EUS-FNB performed with the 19FR provided larger histological specimens and a higher histological diagnostic yield than the 22FR in the diagnosis of AIP. Obtaining a larger amount of tissue may facilitate a definitive diagnosis of AIP. Full article

Background: Pancreatic organoids are a rapidly advancing field of research with new discoveries being made every day. A literature review was performed to answer the question of how relevant 3D pancreatic organoids are for surgery. Materials and Methods: We started our investigation by identifying articles in PubMed within the last 5 years using the keywords ((“pancreatic organoid”, OR “organ-on-a-chip”, OR “pancreatic chip” OR “3D culture methods”) AND pancreatic surgery). Only English articles were included in this literature review. This literature review was performed in a non-systematic way; articles were chosen without a predetermined protocol of inclusion and were based on the aim of the review. Results and Conclusions: There are many promising innovations in the field of 3D cultures. Drug sensitivity testing in particular holds great potential for surgical application. For locally advanced PDAC, EUS-FNB obtained cancer tissue can be cultured as organoids, and after 4 weeks, neoadjuvant treatment could be adjusted for each patient individually. Utilizing this approach could increase the number of R0 resections and possibly cure the disease. Furthermore, microfluidic devices, as a platform for pancreatic islet pre-transplant evaluation or cultivation of beta cells derived from HiPSC in vitro, promise broad application of islet transplantation to T1DM patients in the near future. Full article

Pancreatic cancer is a highly malignant digestive system tumor characterized by covert onset and rapid progression, with a 5-year survival rate of less than 10%. Most patients have already reached an advanced or metastatic stage at the time of diagnosis. Therefore, it is particularly important to study the occurrence, development, and drug resistance mechanisms of pancreatic cancer. In recent years, the development of 3D tumor cell culture technology has provided new avenues for pancreatic cancer research. Patient-derived organoids (PDOs) are micro-organ structures that are obtained directly from the patient’s body and rapidly expand in vitro. PDOs have the ability to self-renew and self-organize and retain the genetic heterogeneity and molecular characteristics of the original tumor. However, the use of organoids is limited because most patients with pancreatic ductal adenocarcinoma (PDAC) are inoperable. Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) is an important method for obtaining tissue samples from non-surgical pancreatic cancer patients. This article reviews the factors that affect the formation of pancreatic cancer organoids using EUS-FNA/FNB. High-quality samples, sterile operations, and optimized culture media are key to successfully generating organoids. Additionally, individual patient differences and disease stages can impact the formation of organoids. Pancreatic cancer organoids constructed using EUS-FNA/FNB have significant potential, suggesting new approaches for research and treatment. Full article