Multimodal endoscopic ultrasound diagnostic evaluation of pancreatic cystic lesions

Aim. To optimize the differential diagnosis of pancreatic cystic lesions by introducing novel endoscopic ultrasound (EUS) technologies into clinical practice. Materials and Methods. The study analyzed the outcomes of multimodal diagnostic evaluation in 424 patients with pancreatic cystic lesions who underwent EUS. Results. In 328 cases (77.4%), conventional B-mode EUS provided sufficient diagnostic information. In 96 cases (22.6%), contrast enhancement was required: 59 patients (61.5%) underwent assessment of contrast uptake by the cyst wall, septa, and solid components; 25 (26%) only by the wall and septa; and in 12 (12.5%) assessment was made ofnodular components of the pancreatic cystic lesions. Retrospective analysis demonstrated that contrast-enhanced EUS increased overall diagnostic accuracy for differentiating cystic neoplasms from post-necrotic pseudocysts by 14.7%, improved detection of solid components within cystic lesions by 11.3%, and enhanced identification of cystic adenocarcinomas or intraductal papillary mucinous neoplasms (IPMNs) associated with adenocarcinoma by 9.9%. The integration of contrast enhancement into the EUS diagnostic algorithm significantly reduced the number of fineneedle aspirations (FNA) required. Conclusion. Both our clinical experience and data from international research underscore the necessity of incorporating multimodal EUS into the diagnostic work-up for cystic pancreatic lesions. Based on the study, an algorithm was developed for applying novel EUS technologies in the differential diagnosis of pancreatic cystic tumors.