How to distinguish pancreatic tumors and assess the necessity for biopsy

Abstract

Endoscopic ultrasonography (EUS) is a valuable and widely used tool for evaluating pancreatic tumors. Accurate decision-making during EUS procedures, particularly for differentiating between benign and malignant lesions based on imaging characteristics and assessing the need for tissue sampling, is crucial. This review provides a comprehensive overview of pancreatic tumor features observed during EUS and highlights the key criteria for distinguishing between malignant and benign conditions. Additionally, we discuss the indications for fine-needle aspiration or biopsy to obtain histopathological and genetic confirmation. Improving our understanding of these critical aspects can help improve diagnostic accuracy and guide clinicians in determining the most appropriate management strategies for patients with pancreatic tumors.

Keywords: Endoscopic ultrasound; Contrast; Elastography; Pancreatic tumor; Fine-needle biopsy

Core Tip: This article highlights the endoscopic ultrasonography, assisted by contrast enhanced sonography and elastography, offers superior accuracy in detecting and characterizing pancreatic tumors. By assessing morphology, vascularity, and tissue stiffness, it differentiates malignant from benign processes and identifies high-risk cystic lesions. Endoscopic ultrasonography-guided fine needle biopsy enables histological and molecular diagnosis, including next generation sequencing for actionable mutations, guiding surgical decisions, neoadjuvant therapy, and targeted treatments. This integrated approach optimizes pancreatic cancer detection, staging, and personalized management while avoiding unnecessary interventions.