Assessment of EUS for diagnosing, staging, and determining resectability of pancreatic cancer: a review

EUS is a highly sensitive test for detecting small pancreatic masses and is accurate in determining vascular invasion of the portal venous system, a major determinant of resectability. Helical CT is an advance over standard CT in its ability to detect and stage pancreatic cancer and should be performed before EUS to rule out metastatic and obviously unresectable cancer. EUS should be performed when no unresectable disease is found or if a tumor is not visualized, although suspected. PET scanning may be a useful adjunct to detect occult metastatic disease, and MRI or angiography may be used to confirm vascular invasion in selected patients. EUS staging and FNA can be performed in a single procedure, unlike CT and CT-FNA, which require separate procedures. EUS-FNA should be considered in the majority of patients undergoing EUS to establish the diagnosis of cancer, determine histologic type, confirm lymph node histology, guide therapy, and assist with counseling of patients and referring physicians.