UNASSIGNED: The objective of this study was to evaluate the clinical feasibility of deep learning reconstruction-accelerated thin-slice single-breath-hold half-Fourier single-shot turbo spin echo imaging (HASTEDL) for detecting pancreatic lesions, in comparison with two conventional T2-weighted imaging sequences: compressed-sensing HASTE (HASTECS) and BLADE.
UNASSIGNED: From March 2022 to January 2023, a total of 63 patients with suspected pancreatic-related disease underwent the HASTEDL, HASTECS, and BLADE sequences were enrolled in this retrospectively study. The acquisition time, the pancreatic lesion conspicuity (LCP), respiratory motion artifact (RMA), main pancreatic duct conspicuity (MPDC), overall image quality (OIQ), signal-to-noise ratio (SNR), and contrast-noise-ratio (CNR) of the pancreatic lesions were compared among the three sequences by two readers.
UNASSIGNED: The acquisition time of both HASTEDL and HASTECS was 16 s, which was significantly shorter than that of 102 s for BLADE. In terms of qualitative parameters, Reader 1 and Reader 2 assigned significantly higher scores to the LCP, RMA, MPDC, and OIQ for HASTEDL compared to HASTECS and BLADE sequences; As for the quantitative parameters, the SNR values of the pancreatic head, body, tail, and lesions, the CNR of the pancreatic lesion measured by the two readers were also significantly higher for HASTEDL than for HASTECS and BLADE sequences.
UNASSIGNED: Compared to conventional T2WI sequences (HASTECS and BLADE), deep-learning reconstructed HASTE enables thin slice and single-breath-hold acquisition with clinical acceptable image quality for detection of pancreatic lesions.

Artificial intelligence (AI) is an epoch-making technology, among which the 2 most advanced parts are machine learning and deep learning algorithms that have been further developed by machine learning, and it has been partially applied to assist EUS diagnosis. AI-assisted EUS diagnosis has been reported to have great value in the diagnosis of pancreatic tumors and chronic pancreatitis, gastrointestinal stromal tumors, esophageal early cancer, biliary tract, and liver lesions. The application of AI in EUS diagnosis still has some urgent problems to be solved. First, the development of sensitive AI diagnostic tools requires a large amount of high-quality training data. Second, there is overfitting and bias in the current AI algorithms, leading to poor diagnostic reliability. Third, the value of AI still needs to be determined in prospective studies. Fourth, the ethical risks of AI need to be considered and avoided.

Introduction: Pancreatic cancer ranks as the fourth deadliest form of cancer. However, it is essential to note that not all pancreatic masses signal primary malignancy. Therefore, it is imperative to establish the correct differential diagnosis, a process further supported by pre-operative biopsy procedures. This meta-analysis aims to compare the diagnostic performance of two minimally invasive biopsy approaches for pancreatic tissue sampling: percutaneous biopsies guided by computed tomography or ultrasound, and transduodenal biopsies guided by endoscopic ultrasound (EUS). Methods: A systematic literature search was conducted in the MEDLINE and Scopus databases. The included studies analyzed the diagnostic performance of the two biopsy methods, and they were assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Statistical analysis was carried out using the RevMan and MetaDisc software packages. Results: The statistical analysis of the results demonstrated the superiority of the percutaneous approach. Specifically, the pooled sensitivity, specificity, LR+, LR-and DOR for the percutaneous approach were 0.896 [95% CI: 0.878-0.913], 0.949 [95% CI: 0.892-0.981], 9.70 [95% CI: 5.20-18.09], 0.20 [95% CI: 0.12-0.32] and 68.55 [95% CI: 32.63-143.98], respectively. The corresponding values for EUS-guided biopsies were 0.806 [95% CI: 0.775-0.834], 0.955 [95% CI: 0.926-0.974], 12.04 [95% CI: 2.67-54.17], 0.24 [95% CI: 0.15-0.39] and 52.56 [95% CI: 13.81-200.09], respectively. Nevertheless, it appears that this statistical superiority is also linked to the selection bias favoring larger and hence more readily accessible tumors during percutaneous biopsy procedures. Conclusions: Concisely, our meta-analysis indicates the statistical superiority of the percutaneous approach. However, selecting the optimal biopsy method is complex, influenced by factors like patient and tumor characteristics, clinical resources, and other relevant considerations.

Pancreaticopleural fistula (PPF) is a rare but serious complication caused by pancreatic lesions that presents primarily with respiratory tract symptoms and pleural effusion. We report a paediatric case of PPF without any respiratory symptoms throughout the course of the disease, including cough or shortness of breath, with only a bulging chest as the first symptom. Imaging revealed a large left pleural effusion and Magnetic Resonance Cholangiopancreatography (MRCP) revealed a fistula formed between the pancreatic tail and the pleural cavity, which penetrated the diaphragm and opened in the central tendon of the diaphragm. The patient eventually underwent resection of the pancreatic tail lesion and repair of the diaphragmatic fistula and recovered soon thereafter.

OBJECTIVE: The pancreatic cancer (PC) is the 4th leading cancer-related death, becoming the second one by 2030, with a 5 year survival rate of 8%. Considering its increased incidence in high-risk categories compared to the general population, we aimed to validate a non-contrast MR protocol, to detect PC in its earliest phase, which could be suitable as a screening tool in high-risk patients.
METHODS: In this retrospective study, we selected 200 patients (> 40 years) from our radiological database, which performed upper abdominal MRI between 2012 and 2017. 100 were negative for pancreatic lesions and 100 positive for pancreatic lesion (< 30 mm). The latter group included: 40 PDAC (pancreatic adenocarcinoma), 42 BD-IPMN (Branch Duct- Intraductal Papillary Mucinous Neoplasm), 10 PNET(pancreatic neuroendocrine tumor), 4 SCN(serous cystic neoplasm), 3 IPS(intrapancreatic spleen), 1 MCN(mucinous cystic neoplasm). Three readers (R1, R2 and R3) with a high, medium and low experience, respectively, analysed, first, the non-contrast MR sequences (single-shot T2w breath-hold, GE T1w FS, DWI and 2D/3D MRCP), and then the standard MR protocol, independently, randomly and anonymously. Readers identified or excluded the presence of pancreatic lesion, in both reading sessions. These results were compared with the histopathological diagnosis, and then divided into 3 different classes of lesions: all lesions, pancreatic adenocarcinoma and solid lesion. Mcnemar\'s test was used to compare the results. The inter-observer agreement was determined according to the kappa statistic in both protocols, and then the inter-protocol agreement was calculated.
RESULTS: The non-contrast MR protocol has reached statistical parameters values ranging between 83% in SE (sensitivity) by R3 and 99% in NPV (negative predictive value) by R1. The standard MR protocol has reported slight increasing statistical parameters compared to those of the proposed one. However, there are not significant statistical differences between the both protocols. The proposed non-contrast MR protocol has reported the highest NPVs in the PDAC group detection (R1: 99%, R2: 99%, R3: 98%). In all groups of lesions, the agreement between the two protocols was excellent for each Reader ranging from 96 to 98%.
CONCLUSIONS: The proposed non-contrast MR protocol showed high PC detection values and a time execution ≤ 20 min. Therefore, it can be proposed as a screening tool in high-risk patients.

Surveillance of pancreatic cysts focuses on the detection of (mostly morphologic) features warranting surgery. European guidelines consider elevated CA19.9 as a relative indication for surgery. We aimed to evaluate the role of CA19.9 monitoring for early detection and management in a cyst surveillance population.
The PACYFIC-registry is a prospective collaboration that investigates the yield of pancreatic cyst surveillance performed at the discretion of the treating physician. We included participants for whom at least one serum CA19.9 value was determined by a minimum follow-up of 12 months.
Of 1865 PACYFIC participants, 685 met the inclusion criteria for this study (mean age 67 years, SD 10; 61% female). During a median follow-up of 25 months (IQR 24, 1966 visits), 29 participants developed high-grade dysplasia (HGD) or pancreatic cancer. At baseline, CA19.9 ranged from 1 to 591 kU/L (median 10 kU/L [IQR 14]), and was elevated (≥37 kU/L) in 64 participants (9%). During 191 of 1966 visits (10%), an elevated CA19.9 was detected, and these visits more often led to an intensified follow-up (42%) than those without an elevated CA19.9 (27%; p < 0.001). An elevated CA19.9 was the sole reason for surgery in five participants with benign disease (10%). The baseline CA19.9 value was (as continuous or dichotomous variable at the 37 kU/L threshold) not independently associated with HGD or pancreatic cancer development, whilst a CA19.9 of ≥ 133 kU/L was (HR 3.8, 95% CI 1.1-13, p = 0.03).
In this pancreatic cyst surveillance cohort, CA19.9 monitoring caused substantial harm by shortening surveillance intervals (and performance of unnecessary surgery). The current CA19.9 cutoff was not predictive of HGD and pancreatic cancer, whereas a higher cutoff may decrease false-positive values. The role of CA19.9 monitoring should be critically appraised prior to implementation in surveillance programs and guidelines.

Pancreatic plasmacytoma is a rare entity of extramedullary plasmacytomas (EMP). It is important to consider pancreatic plasmacytoma in patients diagnosed with multiple myeloma (MM) presenting with obstructive jaundice. We present a case of pancreatic plasmacytoma in a patient with previously diagnosed multiple myeloma and extramedullary plasmacytoma in remission. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) were of great diagnostic and therapeutic value for acute management.

UNASSIGNED: Diagnosis of pancreatic lesions remains a clinical challenge. Early and accurate diagnosis is extremely important for improving the therapeutic usefulness of pancreatic cancers and Endoscopic ultrasonography - fine needle aspiration (EUS-FNA) cytology has come up with this advantage. For current study the authors evaluated the diagnostic accuracy of EUS-FNAC by applying PSC system for reporting pancreaticobiliary cytology and Calculated the malignancy risk associated with the diagnostic categories.
UNASSIGNED: A retrospective study over the period of 2.5 years (April 2017 to Oct 2019) 60 patients in our cohort EUS-FNAC guided unstained fixed and unfixed slides received of pancreatic lesion and were stained with Papanicolau and Giemsa using standard technique and immunocytochemistry, where required Application of Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology Histopathological and clinical follow-up were retrieved.
UNASSIGNED: Our study has comparable results with sensitivity, specificity, PPV, and NPV of 92.8%, 100%, 100%, and 92.59%, respectively. Fuurthermore, a diagnostic accuracy of 96.2%. Risk of malignancy is lower for benign and indeterminate category whereas it is higher for suspicious and malignant categories.
UNASSIGNED: The application of the new proposed terminology for pancreaticobiliary cytology brings standardization. Final diagnosis can be reached by the multidisciplinary approach of EUS-FNA cytology, cell block preparation, immunocytochemistry, and immunohistochemistry; if required, can be adopted as an alternative approach to biopsy. The present study showed high sensitivity and specificity for EUS-FNA in the diagnosis of pancreatic carcinoma, which may influence the treatment plans of both surgeons and oncologists.

Surgical resection remains the gold standard for pancreatic cancer, high-risk pancreatic neuroendocrine tumors (PNETs) and pancreatic cystic neoplasms (PCNs). However, a majority of pancreatic cancers are unresectable at the time of diagnosis. In addition, surgical resection of pancreatic lesions can be associated with morbidity and mortality. A less-invasive alternative therapeutic intervention to avoid short term and long-term adverse events is desirable, as is a minimally-invasive palliative therapy for unresectable or recurrent pancreatic cancers. Endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) allows for selective tissue ablation with minimal injury to the surrounding tissue. EUS-RFA of pancreatic tumors has shown high clinical and technical success with acceptable side effects in pancreatic lesions, lymph nodes, and the celiac plexus. This paper will review the pathophysiology, available technology, safety and efficacy, and future directions of EUS-RFA.

Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) is now an established technique to obtain the pathological diagnosis of solid pancreatic lesions (SPLs), but the diagnosis of small SPLS by EUS-TA can still be difficult. We conducted a literature review and a meta-analysis on the diagnostic yield of EUS-TA according to the tumor size. In a meta-analysis of 33 studies with 6883 cases, a pooled odds ratio (OR) of sensitivity was significantly higher in SPLs of >20 mm (OR 1.64, p = 0.02) and in SPLs of >10 mm (OR 3.05, p = 0.01), but not in SPLs of >30 mm (OR 1.18, p = 0.46). The meta-analysis of accuracy also showed a similar trend: OR of 1.59 in SPLs of >20 mm (p < 0.01) and OR of 3.27 in SPLs of >10 mm (p < 0.01) and OR of 1.03 in SPLs of >30 mm (p = 0.87). The use of a 25-gauge needle tended to improve sensitivity in small SPLs, though not statistically significant: OR of 1.25 and 2.82 in studies with and without a 25-gauge needle (p = 0.08). The use of fine needle biopsy needles, slow pull method, and rapid on-site evaluation did not significantly improve sensitivity in small SPLs. EUS-TA for small SPLs, especially neuroendocrine neoplasms, is reported to have a high risk of adverse events. In summary, the diagnostic yield and safety of EUS-TA for small (<20 mm) SPLs still needs improvement, and the best needle and technique for small SPLs should be further investigated.