• Diagnosis
• Mucinous Cystic Neoplasm
• Radiomics
• Serous Cystic Neoplasm

• Humans
• Pancreatic Neoplasms/diagnostic imaging
• Diagnosis, Differential
• Sensitivity and Specificity
• Tomography, X-Ray Computed/methods
• Radiomics

• EUS-FNB
• Early feeding
• Efficacy
• Safety

• Humans
• Retrospective Studies
• Male
• Female
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects
• Aged
• Middle Aged
• Length of Stay/statistics & numerical data
• Time Factors
• Pancreatic Diseases/pathology
• Pancreatic Diseases/diagnosis
• Pancreatic Diseases/diagnostic imaging
• Enteral Nutrition/methods

• EUS
• EUS‐guided fine needle aspiration
• contrast‐enhanced harmonic EUS
• intraductal papillary mucinous neoplasms
• mural nodule

• Humans
• Diagnosis, Differential
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Pancreas/diagnostic imaging
• Pancreas/pathology
• Pancreatic Cyst/pathology
• Pancreatic Cyst/diagnosis
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/pathology
• ROC Curve
• Sensitivity and Specificity

• EUS-FNA
• cystic fluid analysis
• intraductal papillary mucinous neoplasm (IPMN)
• mucinous cystic neoplasm
• neuroendocrine tumor
• pancreatic cancer

• Endoscopic ultrasound-guided, fine-needle aspiration
• Next-generation sequencing
• Pancreatic cancer
• Pancreatic cysts
• RNA extraction
• Through-the-needle biopsy

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) has been a longstanding challenge. The prognosis of patients with PDAC depends on the stage at diagnosis. It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis. Most molecular studies are done using paraffin-embedded blocks; however, the integrity of DNA and RNA is often compromised in this format. Moreover, RNA isolated from human pancreatic tissue samples is generally of low quality, in part, because of the high concentration of endogenous pancreatic RNAse activity present.

To assess the potential of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling, including next-generation sequencing (NGS).

Thirty-four EUS-FNA samples were included in this study: PDAC (n = 15), chronic pancreatitis (n = 5), pancreatic cysts (n = 14), mucinous cysts (mucinous cystic neoplasia/intraductal papillary mucinous neoplasia) n = 7, serous cystic neoplasms n = 5, and pseudocysts n = 2. Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy (TTNB). Samples were stored at -80 °C until analysis. RNA purity (A260/230, A260/280 ratios), concentration, and integrity (RIN) were assessed. Real-time polymerase chain reaction was conducted on all samples, and small RNA libraries were prepared from solid mass samples.

RNA was successfully extracted from 29/34 (85%) EUS-FNA samples: 100% pancreatic adenocarcinoma samples, 100% chronic pancreatitis samples, 70% pancreatic fluid cyst samples, and 50% TTNB samples. The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples (n = 29) including low-quality RNA specimens. Low concentration and nonoptimal RIN values (no less than 3) of RNA extracted from EUS-FNA samples did not prevent NGS library preparation. The suitability of cyst fluid samples for RNA profiling varied. The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7 (5.0-8.2), which was compatible with that from solid neoplasms [6.2 (0-7.8)], whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0.

The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions, including low-quality RNA specimens.

• Endoscopic ultrasound-guided, fine-needle aspiration
• Pancreatic cancer
• Pancreatic cysts
• RNA extraction
• Through-the-needle biopsy
• Next-generation sequencing

• BD-IPMN
• Dynamic features
• MD-IPMN
• Mural nodule
• Pancreatic cancer
• Pancreatic cyst

• Humans
• Acute Disease
• Carcinoma, Pancreatic Ductal/diagnosis
• Carcinoma, Pancreatic Ductal/pathology
• Cysts/pathology
• Neoplasms, Cystic, Mucinous, and Serous/diagnosis
• Neoplasms, Cystic, Mucinous, and Serous/pathology
• Pancreatic Ducts/pathology
• Pancreatic Intraductal Neoplasms/diagnosis
• Pancreatic Intraductal Neoplasms/pathology
• Pancreatic Neoplasms/pathology
• Pancreatitis/pathology
• Retrospective Studies

• endoscopic ultrasound
• endoscopic ultrasound guided biopsy
• pancreas
• review

• EUS-FNI
• EUS-guided chemoablation
• EUS-nCLE
• LSAM-PTX
• intraductal papillary mucinous neoplasms
• mucinous cystic neoplasms
• pancreatic cancer
• pancreatic cystic lesions

• Carcinoembryonic antigen
• Mucinous cyst
• Non-mucinous cyst
• Pancreatic cancer
• Pancreatic cyst

Currently, there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions (PCLs), especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy (mFB) and needle-based confocal laser-endomicroscopy (nCLE).

To compare the accuracy of endoscopic ultrasound (EUS) and associated techniques for the detection of potentially malignant PCLs: EUS-guided fine needle aspiration (EUS-FNA), contrast-enhanced EUS (CE-EUS), EUS-guided fiberoptic probe cystoscopy (cystoscopy), mFB, and nCLE.

This was a single-center, retrospective study. We identified patients who had undergone EUS, with or without additional diagnostic techniques, and had been diagnosed with PCLs. We determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUS-guided techniques and/or EUS-guided biopsy when available (EUS malignancy detection).

A total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients, EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy (27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques than EUS alone [62/82 (75.6%) vs 8/47 (17%); OR 4.35, 95%CI: 2.70-7.37; P < 0.001]. The highest malignancy detection accuracy was reached when nCLE and direct intracystic mFB were both performed, with a sensitivity, specificity, positive predictive value, negative predictive value and observed agreement of 100%, 89.4%, 77.8%, 100% and 92.3%, respectively (P < 0.001 compared with EUS-alone).

The combined use of EUS-guided mFB and nCLE improves detection of potentially malignant PCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.

• Pancreatic cysts
• Endoscopic ultrasound-guided fine-needle aspiration
• Confocal microscopy
• Image-guided biopsy

Currently, there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions (PCLs), especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy (mFB) and needle-based confocal laser-endomicroscopy (nCLE).

To compare the accuracy of endoscopic ultrasound (EUS) and associated techniques for the detection of potentially malignant PCLs: EUS-guided fine needle aspiration (EUS-FNA), contrast-enhanced EUS (CE-EUS), EUS-guided fiberoptic probe cystoscopy (cystoscopy), mFB, and nCLE.

This was a single-center, retrospective study. We identified patients who had undergone EUS, with or without additional diagnostic techniques, and had been diagnosed with PCLs. We determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUS-guided techniques and/or EUS-guided biopsy when available (EUS malignancy detection).

A total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients, EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy (27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques than EUS alone [62/82 (75.6%) vs 8/47 (17%); OR 4.35, 95%CI: 2.70-7.37; P < 0.001]. The highest malignancy detection accuracy was reached when nCLE and direct intracystic mFB were both performed, with a sensitivity, specificity, positive predictive value, negative predictive value and observed agreement of 100%, 89.4%, 77.8%, 100% and 92.3%, respectively (P < 0.001 compared with EUS-alone).

The combined use of EUS-guided mFB and nCLE improves detection of potentially malignant PCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.

• Pancreatic cysts
• Endoscopic ultrasound-guided fine-needle aspiration
• Confocal microscopy
• Image-guided biopsy

• Confocal laser endomicroscopy
• Intraductal papillary mucinous neoplasms
• Microforceps biopsy
• Mucinous cystic neoplasm
• Pancreatic cystic lesion
• Radiomics

• Cyst Fluid
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Humans
• Pancreas/pathology
• Pancreatic Cyst/diagnostic imaging
• Pancreatic Cyst/pathology
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology

BACKGROUND AND AIMS: Pancreatic malignancy is an important cause of cancer mortality worldwide. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) plays a crucial role in the pre-operative diagnosis of pancreatic lesions. In this study, we have analyzed the cytological spectrum of pancreatic lesions in the Indian population over 12 years, categorized them according to the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSCPC), and assessed the risk of malignancy (ROM) for each of the categories. METHODS: A computerized data search from January 2008 to December 2019 revealed 581 pancreatic EUS-FNA samples, among which surgical follow-up was available for 73 cases. All cytological specimens were reviewed and prospectively classified into one of the six diagnostic categories proposed by the PSCPC. Subsequently, a cytohistological correlation was performed and the ROM was calculated for each category. RESULTS: The cytologic diagnoses included 50 nondiagnostic (category I), 175 negative for malignancy (category II), 19 atypical (category III), 27 neoplastic:benign (category IVA), 30 neoplastic:other (category IVB), 26 suspicious (category V), and 254 malignant (category VI) cases. ROM for non-diagnostic aspirates, nonneoplastic benign specimens, atypical cases, neoplastic:benign, neoplastic:other, suspicious for malignancy, and the malignant category was 16.7%, 7.1%, 33.3%, 0.0%, 20.0%, 100%, and 78.6%, respectively. CONCLUSION: We document an increased risk of malignancy from category I to category VI of the PSCPC. The malignancy risk for category VI (malignant) was statistically significant in our study but was lower in comparison to the values reported by other authors. Nonetheless, such an approach would establish transparent communication between the pathologist and the clinician, as well as aid the clinician in decision making, particularly in intermediate categories.

• EUS-FNA
• Papanicolaou Society of Cytopathology
• pancreas
• risk of malignancy
• risk stratification.

• carcinoembryonic antigen
• glucose
• pancreatic cystic lesion

Needle-based confocal laser endomicroscopy (nCLE) is a procedure in which an AQ-Flex nCLE mini-probe is passed through an EUS-FNA needle into a pancreatic lesion to enable subsurface in vivo tissue analysis. In this study, we conducted a systematic review and meta-analysis of nCLE for the diagnosis of pancreatic lesions.

We conducted a comprehensive search of several databases and conference proceedings, including PubMed, EMBASE, Google-Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to March 2020). The primary outcomes assessed the pooled rate of diagnostic accuracy for nCLE and the secondary outcomes assessed the pooled rate of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and adverse events (AE) of nCLE to diagnose premalignant/malignant pancreatic lesions.

Eleven studies on 443 patients were included in our analysis. The pooled rate of diagnostic accuracy of EUS nCLE was 83% (95 confidence interval [CI] = 79–87; I² = 0). The pooled rate of sensitivity, specificity, PPV and NPV of EUS nCLE was 85.29% (95% CI = 76.9–93.68; I² = 85%), 90.49% (95% CI = 82.24–98.74; I² = 64%), 94.15% (95% CI = 88.55–99.76; I² = 68%), and 73.44% (95% CI = 60.16–86.72; I² = 93%), respectively. The total AE rate was 5.41% (±5.92) with postprocedure pancreatitis being the most common AE at 2.28% (±3.73).

In summary, this study highlights the rate of diagnostic accuracy, sensitivity, specificity, and PPV for distinguishing premalignant/malignant lesions. Pancreatic lesions need to be further defined with more validation studies to characterize CLE diagnosis criteria and to evaluate its use as an adjunct to EUS-FNA.

• lesions
• meta-analysis
• needle-based confocal laser endomicroscopy
• pancreatic

• FNA
• Papanicolaou reporting system
• cytology
• pancreas

In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features (size ≥ 3 cm, mural nodule, or Wirsung dilation).

To evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm.

Retrospective study of PCLs < 3 cm (2007–2016) undergoing EUS-FNA. Clinical, EUS and pancreatic cystic fluid (PCF) data were prospectively registered. Performance of EUS-FNA with PCF analysis for the detection of malignancy and accuracy in surgical cohort were analyzed.

We evaluated 115 patients with PCLs < 3 cm who underwent EUS-FNA. 19 patients underwent surgery, 7 had malignant, 8 pre-malignant, and the remaining 4 benign lesions. Mass/mural nodule was present in 27% of the cysts, CEA level was higher than 192 ng/mL in 39.4% of patients, and only 35% of cytologic samples were informative. Nevertheless, additional FNA for PCF analysis improved the diagnostic performance of EUS imaging—AUC = 0.80 versus AUC = 60.

EUS-FNA has good accuracy in PCLs < 3 cm. It confirmed malignancy even in lesions without worrisome features (nodule/mass), with two in every five resections showing high-risk/malignant lesions. EUS-FNA was also useful to diagnose benign cysts, possibly allowing surveillance to be stopped in one in every five patients.

• CEA
• EUS-FNA
• IPMN
• MCN
• Pancreatic cyst
• Small size

• FNA
• IPMN
• histology
• intraductal papillary mucinous neoplasm
• serous cystadenoma

• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Humans
• Pancreas
• Pancreatic Cyst/diagnostic imaging
• Pancreatic Neoplasms/diagnostic imaging

• CEA
• cytology
• endoscopic ultrasound
• fine-needle aspiration
• pancreatic cystic neoplasm

• EUS
• FNA
• cysts
• pancreas
• yield

• Hepatobiliary
• flexible endoscopy
• interventional endoscopy

The present study aimed to compare the diagnostic accuracy between conventional smear (CS) and liquid-based preparation (LBP) in endoscopic ultrasonography-fine needle aspiration cytology (EUS-FNAC) of pancreatic lesions. Using 31 eligible studies, the diagnostic accuracy of cytologic examination in CS and LBP was evaluated through a conventional meta-analysis and diagnostic test accuracy review. Overall concordance rates were 82.8% (95% confidence interval [CI], 79.8–85.5%) and 94.0% (95% CI, 84.4–97.8%) in CS and LBP, respectively. CS with rapid on-site evaluation (ROSE) showed a higher concordance rate than CS without ROSE. In CS, the pooled sensitivity and specificity were 89.8% (95% CI, 85.2–93.1%) and 95.0% (95% CI, 90.0–97.6%), respectively. The diagnostic odds ratio (OR) and area under curve (AUC) of the summary receiver operating characteristic (SROC) curve were 90.32 (95% CI, 43.85–147.11) and 0.945, respectively. In LBP, the pooled sensitivity and specificity were 80.9% (95% CI, 69.7–88.7%) and 99.9% (95% CI, 1.5–100.0%), respectively. The diagnostic OR and AUC of the SROC curve were 57.21 (95% CI, 23.61–138.64) and 0.939, respectively. Higher concordance rates were found in CS with ROSE and LBP in EUS-FNAC of pancreatic lesions. Regardless of the cytologic preparation method, EUS-FNAC is a useful and accurate diagnostic tool for pancreatic lesions.

• conventional smear
• diagnostic test accuracy review
• endoscopic ultrasonography-fine needle aspiration cytology
• liquid-based preparation
• meta-analysis
• pancreas

• Biomarker
• Diagnostic
• IPMN
• Molecular
• Pancreatic cyst

• texture analysis
• imaging
• pancreas
• pancreatic cysts
• pancreatic ductal adenocarcinoma (pdac)
• pancreatic neuroendocrine tumor (pnet)

• Biopsy
• Cyst fluid
• Endoscopic ultrasound
• Endoscopic ultrasound-guided fine needle aspiration
• Pancreatic cyst lesion

Pancreatic cystic lesions (PCLs) have been increasingly recognized in clinical practice. Although inflammatory cysts (pseudocysts) are the most common PCLs detected by cross-sectional imaging modalities in symptomatic patients in a setting of acute or chronic pancreatitis, incidental pancreatic cysts with no symptoms or history of pancreatitis are usually neoplastic cysts. For these lesions, it is imperative to identify mucinous cysts (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) due to the risk of their progression to malignancy. However, no single imaging modality alone is sufficient for a definitive diagnosis of all PCLs. The cyst fluid obtained by endoscopic ultrasound-guided fine needle aspiration provides additional information for the differential diagnosis of PCLs. Current recommendations suggest sending cyst fluid for cytology evaluation and measurement of carcinoembryonic antigen (CEA) levels. Unfortunately, the sensitivity of cytology is greatly limited, and cyst fluid CEA has demonstrated insufficient accuracy as a predictor of mucinous cysts. More recently, cyst fluid glucose has emerged as an alternative to CEA for distinguishing between mucinous and nonmucinous lesions. Herein, the clinical utility of cyst fluid glucose and CEA for the differential diagnosis of PCLs was evaluated.

• Carcinoembryonic antigen
• Differential diagnosis
• Fine-needle biopsy
• Glucose
• Pancreatic cyst
• Tumor marker

• Carcinoembryonic Antigen/analysis
• Cyst Fluid/chemistry
• Diagnosis, Differential
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Glucose/analysis
• Humans
• Pancreatic Cyst/diagnosis
• Pancreatic Cyst/pathology
• Pancreatic Intraductal Neoplasms/diagnosis
• Pancreatic Intraductal Neoplasms/pathology

• Endoscopic ultrasound
• Fine-needle aspiration biopsy
• Malignancy risk
• Pancreas
• Papanicolaou Society of Cytopathology

• Adult
• Aged
• Aged, 80 and over
• Biliary Tract Neoplasms/epidemiology
• Biliary Tract Neoplasms/pathology
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/statistics & numerical data
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Neoplasms/epidemiology
• Pancreatic Neoplasms/pathology
• Papanicolaou Test/standards
• Papanicolaou Test/statistics & numerical data
• Societies, Medical/standards

• Endoscopic ultrasound
• Fine needle aspiration
• Pancreatic cysts
• Tissue acquisition in pancreatic cysts

• Contrast-enhanced endoscopic ultrasonography
• Endoscopic ultrasonography
• Pancreatic cancer

• Diagnosis, Differential
• Elasticity Imaging Techniques/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Endosonography/methods
• Humans
• Magnetic Resonance Imaging/methods
• Neoplasm Staging
• Pancreatic Diseases/diagnosis
• Pancreatic Diseases/pathology
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/pathology
• Tomography, X-Ray Computed/methods

• cystic lesion
• endoscopic diagnosis
• endoscopic ultrasonography
• pancreas

• EUS-FNA
• IPMN
• microbiopsy forceps
• moray
• pancreatic cancer
• pancreatic cysts

• Atypical
• Indeterminate
• Pancreas
• Survey
• Suspicious

• CEA
• DNA
• EUS-FNA
• Genetic analysis
• KRAS or GNAS
• Pancreatic cystic neoplasm

• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor/blood
• Biomarkers, Tumor/genetics
• Carcinoembryonic Antigen/blood
• Carcinoma/blood
• Carcinoma/genetics
• Carcinoma/pathology
• Carcinoma/therapy
• Chromogranins/genetics
• DNA Mutational Analysis
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Exons
• Female
• GTP-Binding Protein alpha Subunits, Gs/genetics
• Genetic Predisposition to Disease
• Humans
• Male
• Middle Aged
• Mutation
• Neoplasms, Cystic, Mucinous, and Serous/blood
• Neoplasms, Cystic, Mucinous, and Serous/genetics
• Neoplasms, Cystic, Mucinous, and Serous/pathology
• Neoplasms, Cystic, Mucinous, and Serous/therapy
• Pancreatic Cyst/blood
• Pancreatic Cyst/genetics
• Pancreatic Cyst/pathology
• Pancreatic Cyst/therapy
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/genetics
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/therapy
• Phenotype
• Predictive Value of Tests
• Proto-Oncogene Proteins p21(ras)/genetics
• Retrospective Studies

• Bolsa 2015 Clube Português do Pâncreas

• ROSE
• cytopathologist
• diagnostic yield
• endoscopic ultrasound

• Pancreatic cystic lesions
• biomarker
• cyst fluid
• next-generation sequencing

• Cyst Fluid/chemistry
• High-Throughput Nucleotide Sequencing
• Humans
• Neoplasms, Cystic, Mucinous, and Serous/diagnosis
• Neoplasms, Cystic, Mucinous, and Serous/genetics
• Neoplasms, Cystic, Mucinous, and Serous/therapy
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/genetics
• Pancreatic Neoplasms/therapy
• Sequence Analysis, DNA
• Sequence Analysis, RNA

• cell-block
• core biopsy
• cytology
• endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
• immunohistochemistry

• Contrast-enhanced
• Cyst
• Elastography
• Endomicroscopy
• Endosonography
• Endosonography-fine needle aspiration
• Harmonics
• Lymph nodes
• Pancreas

• Biopsy, Fine-Needle/methods
• Contrast Media/administration & dosage
• Cystadenoma, Mucinous/diagnostic imaging
• Diagnosis, Differential
• Elasticity Imaging Techniques/instrumentation
• Elasticity Imaging Techniques/methods
• Endosonography/instrumentation
• Endosonography/methods
• Female
• Humans
• Lymph Nodes/diagnostic imaging
• Lymphatic Metastasis
• Microscopy, Confocal/instrumentation
• Microscopy, Confocal/methods
• Neoplasm Staging
• Ovarian Neoplasms/diagnostic imaging
• Pancreas/diagnostic imaging
• Pancreas/pathology
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Pancreatic Pseudocyst/diagnostic imaging
• Predictive Value of Tests
• Ultrasonography, Doppler

• Early detection of cancer
• Genetic predisposition to disease
• Hereditary
• Neoplastic syndromes
• Pancreatic cyst
• Pancreatic neoplasms