Pancreatic cancer is one of the leading causes of cancer-related death. It has a poor 5-year
survival rate of around8-9%. This is primarily because of most patients with pancreatic
adenocarcinoma progress to either metastatic or locally advanced disease while in the
asymptomatic phase. However, if pancreatic cancer is detected in the early stage (i.e., less
than 2.0 cm), it has a relatively better prognosis.
Traditionally, transabdominal ultrasound or computed tomography CT scanning are used to
diagnose pancreatic lesions. However, transabdominal ultrasound is limited because it cannot
be used to visualize the entire pancreas due to intervening fat or air. Endoscopic
ultrasonography (EUS) is currently an essential emerging tool for the work-up of
pancreaticobiliary neoplasms. (EUS) is an ultrasound (US) technique in which the tip of the
endoscope is equipped with a high-frequency transducer. High-resolution images of the
pancreas can be obtained through the esophagus, stomach, and duodenum, without the disrupting
effects of intervening gas, fat, and bone. EUS is now regarded as the most sensitive imaging
modality for the detection of even a very small pancreatic lesion. Endoscopic ultrasound
(EUS) elastography is a novel non-invasive technique that is used for the evaluation of
pancreatic tissue which was first reported in 2006 and can be used for distinguishing benign
from malignant pancreatic masses. Therefore, accurate detection of small cancers is important
for reducing the mortality rate from pancreatic cancer. The equipment can be coupled with
conventional EUS without the need for additional devices. There are two types of EUS
elastography, strain and shear wave. Strain elastography estimates the stiffness and
elasticity of the target tissue by measuring the degree of strain produced in response to
compression. Shear wave elastography involves the emission of focused ultrasound from the
probe to the target tissue, the so-called 'acoustic radiation force impulse' (ARFI), and the
stiffness of the target tissue is then estimated by measuring the propagation speed of the
shear wave. Only strain elastography is so far available for EUS. EUS elastography is used to
characterize pancreatic masses and lymph node metastases of pancreatic cancer as well as to
judge the severity of chronic pancreatitis with the evaluation of lesion elasticity
EUS-guided fine needle aspiration (EUS-FNA) has been generally used for the sampling of
pancreatic tissues since it was first reported in 1992. In general, 19G-25G caliber needles
are inserted under EUS guidance for the pathological diagnosis of pancreatic cancer and lymph
nodes and/or hepatic focal lesions. The overall complication rate of EUS-FNA is including
complications such as pain, bleeding, and pancreatitis.
EUS FNA remains the gold standard in diagnosing pancreatic lesions and pancreatic cancer via
tissue acquisition with a sensitivity of 80-85% and a specificity of 100 %, however, the
diagnostic accuracy of EUS guided FNA is limited and EUS FNA can be associated with risks and
complications. Many pre-procedural and procedural considerations must be assessed before
performing EUS guided FNA. The location of the lesion, lack of adequate visualization, lack
of experience of the endoscopist, lack of onsite pathology, and lack of adequate sampling are
all limitations in diagnostic yield. False negatives can also occur in up to 40% of cases. In
our multi-center experience, we are going to focus on the use of EUS elastography to direct
the site of fine-needle aspiration in tissue acquisition of solid pancreatic lesions and its
effect on the accuracy of diagnosis and detection of solid pancreatic lesions.