Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2016; 22(39): 8658-8669
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8658
Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?
Andrew C Storm, Linda S Lee
Andrew C Storm, Linda S Lee, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest statement: Both authors have no conflicts of interest to disclose including no pharmaceutical or industry support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Linda S Lee, Assistant Professor, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, United States.
Telephone: +1-617-2780359 Fax: +1-617-2645132
Received: July 1, 2016
Peer-review started: July 4, 2016
First decision: August 8, 2016
Revised: August 24, 2016
Accepted: September 14, 2016
Article in press: September 14, 2016
Published online: October 21, 2016

The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.

Keywords: Endoscopic ultrasound, Fine needle aspiration, Pancreatic cancer, Pancreatic mass, Endoscopy

Core tip: Evidence-based techniques to increase the diagnostic yield during endoscopic ultrasound-guided fine needle aspiration (FNA) of pancreatic masses include: (1) use of general anesthesia; (2) use smaller (22 or 25G) needles for transduodenal FNA; (3) use If histology is desired, use 19G or core biopsy needles; (4) use suction; (5) use the “fanning technique”; and (6) use on-site cytopathologist or perform 7 needle passes.