Refining Pancreatic Cystic Neoplasm Assessment: The Incremental Role of Endoscopic Ultrasound and Fine Needle Aspiration

Highlight

• Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) adds significant diagnostic specificity in patients with pancreatic cystic neoplasms (PCNs) initially evaluated by MRI.
• EUS identifies morphological high-risk features (MHRF) missed by MRI in a subset of patients, which are associated with a substantial upgrade rate for malignancy.
• Patients with MHRF detected on MRI but not confirmed by EUS have a high likelihood of remaining cancer-free on surveillance.
• Decision-curve analysis highlights the greatest clinical benefit of EUS combined with FNA in patients whose MRI does not reveal MHRF.

Study Background