Diagnosis of Pancreatic Cystic Neoplasms: Clinical Utility of Endoscopic Ultrasound

Pancreatic cystic neoplasms (PCNs) are being detected with increasing frequency due to advances in imaging technology. The challenge for clinicians is accurately differentiating benign lesions from those with malignant potential, which is a crucial step in appropriate patient management. While modern cross-sectional imaging modalities, such as computed tomography and magnetic resonance imaging, are essential for initial screening, they often do not have the specificity required for a definitive diagnosis. Endoscopic ultrasound (EUS) has emerged as an invaluable tool that provides high-resolution images of internal cystic structures. However, the major advantage of EUS is the ability to facilitate a suite of advanced diagnostic techniques. This review explores the current landscape of EUS-based modalities for evaluating PCNs, including cyst fluid analysis, contrast-enhanced EUS, through-the-needle biopsy, and advanced visualization methods, such as needle-based confocal laser endomicroscopy and cystoscopy. We focused on the advantages, diagnostic performance, and limitations of each technique to provide a practical overview for clinical application.