Impact of endoscopic ultrasound elastography in pancreatic lesion evaluation

Abstract

Pancreatic malignancy still becomes a major global problem and is considered as one of the most lethal cancers in the field of gastroenterology. Most patients come in the late stage of the disease due to organ’s location, and until now the treatment result is still far away from satisfaction. Early detection is still the main key for good, prolonged survival. However, discerning from other types of tumor sometimes is not easy. Endoscopic ultrasound (EUS) is still the best tool for pancreatic assessment, whereas fine-needle aspiration biopsy (FNAB) is considered as the cornerstone for further management of pancreatic malignancy. Several conditions have become a concern for EUS-FNAB procedure, such as risk of bleeding, pancreatitis, and even needle track-seeding. Recently, an artificial intelligence innovation, such as EUS elastography has been developed to improve diagnostic accuracy in pancreatic lesions evaluation. Studies have shown the promising results of EUS elastography in improving diagnostic accuracy, as well as discerning from other tumor types. However, more studies are still needed with further considerations, such as adequate operator training, expertise, availability, and its cost-effectiveness in comparison to other imaging options.

Keywords: Pancreatic malignancy; Pancreatic lesion; Endoscopic ultrasound; Fine needle aspiration biopsy; Elastography

Core Tip: The application of endoscopic ultrasound (EUS) elastography is one of the most potential roles of artificial intelligence in pancreaticobiliary disorders. EUS elastography becomes a promising method to evaluate pancreatic lesions by providing information of tissue elasticity, which may correlate with malignant characteristics. Incomplete elastographic delineation, especially in large tumor size, as well as compelling intra-/inter-observer variability also still become limitations in performing adequate EUS elastography examination on pancreatic lesions.