The role of endoscopic ultrasound in diagnosis and staging of pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a malignant neoplasia with an incidence and a prevalence that are progressively growing. It is estimated that in 2030 it will be the third most common tumor, after lungs and liver. This is due at first because of a delay in the development of new therapies able to change PDAC patients' prognosis and also because at diagnosis the tumor is already in advanced stages. During last years, endoscopic ultrasound (EUS), thanks to its versatility, became the first-choice technique in pancreatic diseases. EUS can be used, in example, in the screening of high-risk subjects (HRI) for the development of PDAC. The screening program is reserved to subjects with germinal mutation in high risk genes and subjects with a familial pancreatic cancer history. EUS was found to be a technique highly sensitive with a slightly good specificity in the detection of pancreatic lesions in HRIs; its diagnostic accuracy is superior to MRI and CT-scan, most of all for small size lesions (respectively 93%, 67% and 53%). A fundamental role of EUS is represented by the PDAC diagnosis. Even in this case a higher sensitivity respect to MRI and CT-scan can be observed (94% vs 79% vs 74%). The diagnostic ability could be improved by the use of ancillary techniques as elastography or contrast agents. Furthermore, with EUS it is possible to obtain a cytological or a histological specimen for the diagnosis of PDAC with low risk of adverse events and a high diagnostic accuracy. Considering therapeutic approaches, EUS can be used for pain control performing the celiac plexus neurolysis; new future insights can be found in the possibility of ablative treatments of pancreatic solid neoplasia.