Resectable pancreatic solid lesions: Time to move from surgical diagnosis?

Area of Science:

• Gastroenterology
• Oncology
• Radiology

Background:

• Pancreatic solid lesions (PSLs) can be benign or malignant, necessitating accurate differentiation.
• Multidetector computed tomography (MDCT) with a pancreatic protocol aids in stratifying the diagnostic workup for PSLs.
• Current guidelines indicate tissue biopsy for patients with metastatic or unresectable PSLs who are candidates for chemotherapy.

Purpose of the Study:

• To evaluate the role of MDCT findings in guiding tissue acquisition for PSLs.
• To assess the impact of novel EUS-guided biopsy techniques on the diagnosis of resectable PSLs.
• To determine the necessity of preoperative tissue diagnosis for resectable PSLs in light of evolving technologies and neoadjuvant chemotherapy.

Main Methods:

• Review of diagnostic strategies for PSLs based on MDCT characteristics.
• Evaluation of endoscopic ultrasound (EUS)-guided tissue acquisition, including fine-needle aspiration (FNA) and fine-needle biopsy (FNB).
• Consideration of advancements in EUS-FNB for molecular analysis (DNA/RNA sequencing) and their clinical implications.

Main Results:

• MDCT findings help stratify the need for tissue biopsy in PSLs.
• EUS-guided tissue acquisition is the gold standard for definitive diagnosis in unresectable PSLs.
• Novel EUS-FNB techniques improve diagnostic accuracy and enable molecular profiling, potentially altering the management of resectable PSLs.

Conclusions:

• The diagnostic approach to PSLs should integrate MDCT findings and advanced EUS-guided biopsy capabilities.
• Preoperative tissue diagnosis for resectable PSLs may become increasingly important due to technological advancements and neoadjuvant chemotherapy efficacy.
• A multidisciplinary consensus is needed to update guidelines on preoperative tissue diagnosis for resectable PSLs.