Endoscopic ultrasound-guided fine needle aspiration in the diagnosis and staging of pancreatic tumors.

Endoscopic ultrasound (EUS) is useful in the detection of pancreatic carcinoma. One of its major limitations is the lack of specificity for malignancy, both for the primary tumor and for associated lymph nodes due to its inability to distinguish malignant infiltration from benign inflammation. EUS-guided fine needle aspiration (FNA) has now been developed, which allows for a tissue diagnosis of the primary tumor as well as lymph nodes, liver metastasis, and peritoneal/pleural fluid. The addition of EUS-guided FNA, with the specificity of a tissue diagnosis, to the high sensitivity and vascular assessment of EUS alone makes this the modality of choice for the diagnosis and staging of pancreatic carcinoma. The results of preliminary studies along with discussion regarding the technique, safety, cytologic adequacy, diagnostic accuracy, clinical utility, and future trends of EUS-guided FNA in pancreatic tumors are presented.