Iranian Journal of Pathology

Correlation Between Endosonography and Cytopathology in the Diagnosis of Pancreatic Masses: A Cross-Sectional Study

Articles in Press

Document Type : Original Research

Authors

Maryam Vajihinejad 1
Ali Hatefi Ardakani 2
Ashkan Moradi 1
Roya Sadat Hosseini Hemmat Abadi 3

1 Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Gastroenterology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

10.30699/ijp.2026.2062736.3475
Abstract
Background & Objective: Pancreatic cancer is among the deadliest malignancies, with an increasing incidence and a 5-year survival rate below 10%. Due to the lack of sensitive and specific diagnostic markers, its identification remains challenging. Endoscopic ultrasound (EUS) has become an invaluable staging tool, particularly when CT scans fail to reveal masses. When combined with fine needle aspiration (FNA) or fine needle biopsy (FNB), EUS facilitates diagnostic confirmation.
Methods: This cross-sectional study was conducted in 2023 at Shahid Sadoughi University of Yazd and involved 110 patients. Data on age, gender, pathology diagnosis, and findings from EUS, FNA, and FNB were retrospectively collected and analyzed using SPSS version 22.
Results: Of the 110 patients, 74 (67%) were male and 36 (33%) were female, with a mean age of 61.5 years. Adenocarcinoma was the predominant diagnosis, accounting for 70% of cases. The most common clinical presentations were abdominal pain (observed in 75% of patients), jaundice, and weight loss. There was 85% agreement between EUS and pathological results. A malignant mass was identified in 69% of FNA cases, with the pancreatic head most frequently involved. Notably, diagnostic concordance between FNA and FNB reached complete agreement (100%) in lesions located in the pancreatic tail.
Conclusion: The robust correlation between EUS and cytopathological findings and the outstanding agreement between FNA and FNB underscore the pivotal role of integrating these techniques for accurate pancreatic mass diagnosis. These findings validate the current diagnostic practices and provide new insights that can potentially improve patient outcomes.

Keywords

endosonographic, pancreatic cancer, EUS-FNA, fine needle biopsy

Subjects

1.      Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, et al. Pancreatic cancer. Nat Rev Dis Primers. 2016;2(1):1-22. [DOI:10.1038/nrdp.2016.22] [PMID]
2.      Iglesias-Garcia J, de la Iglesia-Garcia D, Olmos-Martinez JM, Larino-Noia J, Dominguez-Munoz JE. Differential diagnosis of solid pancreatic masses. Minerva Gastroenterol Dietol. 2020;66(1):70-81. [DOI:10.23736/S1121-421X.20.02646-X] [PMID]
3.      US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, et al. Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;322(5):438-44.      [DOI:10.1001/jama.2019.10232] [PMID]
4.      Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. [DOI:10.3322/caac.21763] [PMID] [PMCID]
5.      Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913-21. [DOI:10.1158/0008-5472.CAN-14-0155] [PMID] [PMCID]
6.      Raptis DA, Fessas C, Belasyse-Smith P, Kurzawinski TR. Clinical presentation and waiting time targets do not affect prognosis in patients with pancreatic cancer. Surgeon. 2010;8(5):239-46.          [DOI:10.1016/j.surge.2010.03.001] [PMID]
7.      Wood LD, Canto MI, Jaffee EM, Simeone DM. Pancreatic cancer: pathogenesis, screening, diagnosis, and treatment. Gastroenterology. 2022;163(2):386-402. [DOI:10.1053/j.gastro.2022.03.056] [PMID] [PMCID]
8.      Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990;85(4): 350-5.
9.      Vitali F, Zundler S, Jesper D, Wildner D, Strobel D, Frulloni L, et al. Diagnostic endoscopic ultrasound in pancreatology: focus on normal variants and pancreatic masses. Visc Med. 2023;39(5):121-30.      [DOI:10.1159/000533432] [PMID] [PMCID]
10.    DeWitt J, Devereaux B, Chriswell M, McGreevy K, Howard T, Imperiale TF, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med. 2004;141(10):753-63. [DOI:10.7326/0003-4819-141-10-200411160-00006] [PMID]
11.    Queneau PE, Sauve G, Koch S, Thibault P, Cleau D, Heyd B, et al. The impact on clinical practice of endoscopic ultrasonography used for the diagnosis and staging of pancreatic adenocarcinoma. JOP. 2001;2(3):98-104.
12.    Elhanafi S, Mahmud N, Vergara N, Kochman ML, Das KK, Ginsberg GG, et al. Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer. J Gastroenterol Hepatol. 2019;34(5):907-13. [DOI:10.1111/jgh.14540] [PMID] [PMCID]
13.    Kovacevic B, Toxvaerd A, Klausen P, Larsen MH, Grutzmeier S, Detlefsen S, et al. Tissue amount and diagnostic yield of a novel franseen EUS-FNB and a standard EUS-FNA needle-A randomized controlled study in solid pancreatic lesions. Endosc Ultrasound. 2023;12(3):319-25. [PMID] [PMCID]          [DOI:10.1097/eus.0000000000000007]
14.    Itonaga M, Ashida R, Kitano M. Updated techniques and evidence for endoscopic ultrasound-guided tissue acquisition from solid pancreatic lesions. DEN Open. 2025;5(1):e399. [DOI:10.1002/deo2.399] [PMID] [PMCID]
15.    Notohara K, Nakamura K. Tissue processing of endoscopic ultrasound-guided fine-needle aspiration specimens from solid pancreatic lesions. J Med Ultrason (2001). 2024;51(2):261-74. [DOI:10.1007/s10396-023-01387-8] [PMID]
16.    Farnes I, Paulsen V, Verbeke CS, Tonnesen CJ, Aabakken L, Labori KJ. Performance and safety of diagnostic EUS FNA/FNB and therapeutic ERCP in patients with borderline resectable and locally advanced pancreatic cancer - results from a population-based, prospective cohort study. Scand J Gastroenterol. 2024;59(4):496-502. [DOI:10.1080/00365521.2023.2290456] [PMID]
Iranian Journal of Pathology

Articles in Press, Accepted Manuscript
Available Online from 20 February 2026

  • Receive Date 05 June 2025
  • Revise Date 23 November 2025
  • Accept Date 03 February 2026

Home

Guide for Authors

Submit Manuscript

Contact Us