Advances in Endoscopic Ultrasonography-Based Diagnosis of Pancreatic Lesions: Narrative Review

Most cases of pancreatic cancer are discovered at an unresectable stage; thus, the prognosis is poor. Therefore, early detection of pancreatic cancer, as well as differential diagnosis of pancreatic neoplasms, is important. Endoscopic ultrasonography (EUS) is one of the most reliable and efficient diagnostic modalities for pancreatic neoplasms because its spatial resolution is superior to that of other imaging modalities. Although EUS was first utilized for diagnosis only 40 years ago, it is now used widely in clinical practice. Moreover, advances in imaging enhancement techniques such as contrast-enhanced EUS, EUS elastography (including strain elastography and shear wave elastography), and EUS microvascular imaging (detective flow imaging) have improved the diagnosis of pancreatic neoplasms. Indeed, pathological diagnosis coupled with EUS-guided tissue acquisition (EUS-TA) is superior to other imaging modalities. At present, EUS-TA is used not only for diagnosis but also to collect tissue samples for cancer gene panel testing, taking us a step closer to a personalized approach to treatments for pancreatic cancer. In this review, we discuss the current status of EUS, recent advances in technology, and new data regarding the use of EUS to diagnose pancreatic neoplasms, including solid and cystic lesions.