Evaluation of Pancreatic Lesions: Comparative Analysis of Endoscopic Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging

Background and Objectives: This study aimed to evaluate the diagnostic performance of endoscopic ultrasound (EUS) in comparison with computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of pancreatic lesions, and to assess the concordance of imaging findings with histopathological outcomes. Materials and Methods: A total of 76 patients who underwent EUS for pancreatic lesions between April 2021 and April 2022 were retrospectively analyzed. EUS findings were compared with CT and/or MRI in terms of lesion size, localization, and morphological characteristics. Histopathological results and laboratory parameters, including serum amylase, lipase, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9), were evaluated. Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated. Results: The study included 76 patients (55.3% male; mean age 59.93 ± 14.03 years). EUS demonstrated superior detection of lesions smaller than 2 cm (42.1% vs. 35.5%; p < 0.01) and a higher ability to identify solid components (17.1% vs. 9.7%; p < 0.01) compared to cross-sectional imaging. While overall sensitivity for malignancy was comparable between modalities, EUS showed higher specificity (58.33%) and diagnostic accuracy (55.26%). Pancreatic duct dilation, solid lesion morphology, larger lesion size, and elevated CA 19-9 levels were significantly associated with malignant pathology (p < 0.05). A descriptive agreement analysis revealed moderate concordance between EUS and radiological imaging in lesion size classification and morphological characterization. Conclusions: EUS demonstrates superior performance in detecting small pancreatic lesions and identifying solid components associated with malignancy. Although its sensitivity is comparable to CT and MRI, its higher specificity and diagnostic accuracy support its important role in lesion characterization. However, EUS should be considered complementary to cross-sectional imaging within a multimodal diagnostic approach. Integration of imaging findings with biochemical markers may further enhance diagnostic accuracy and clinical decision-making. Larger prospective studies with standardized protocols are warranted to validate these findings.