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Meta-Analysis
. 2017 Apr 17;4(4):CD010213.
doi: 10.1002/14651858.CD010213.pub2.

Imaging modalities for characterising focal pancreatic lesions

Lawrence Mj Best  1 , Vishal Rawji  2 , Stephen P Pereira  3 , Brian R Davidson  1 , Kurinchi Selvan Gurusamy  1
Affiliations
Meta-Analysis

Imaging modalities for characterising focal pancreatic lesions

Lawrence Mj Best et al. Cochrane Database Syst Rev. .

Abstract

Background: Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions.

Objectives: To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions.

Search methods: We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively.

Selection criteria: We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively.

Data collection and analysis: Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data.

Main results: We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing.

Authors' conclusions: We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.

PubMed Disclaimer

Conflict of interest statement

This project was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure, Cochrane Programme Grant, or Cochrane Incentive funding to the Upper Gastrointestinal and Pancreatic Diseases Group and Cochrane Hepato‐Biliary Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health.

LMJB: none known.

VR: none known.

SPP: none known.

BRD: none known.

KSG: none known.

Figures

1
1
Clinical pathway. Abbreviations: Ca 19‐9: carbohydrate antigen 19‐9
 CT: computed tomography
 EUS: endoscopic ultrasound
 MRI: magnetic resonance imaging
 PET: positron emission tomography
2
2
Study flow diagram.
3
3
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
4
4
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
5
5
Forest plot ‐ Cancerous versus benign or precancerous.
6
6
Forest plot ‐ Cancerous versus benign.
7
7
Forest plot ‐ Precancerous or cancerous versus benign.
8
8
Forest plot ‐ Cancerous (invasive carcinoma) versus precancerous (dysplasia).
9
9
Forest plot ‐ Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia).
10
10
Forest plot ‐ Cancerous (invasive carcinoma) versus precancerous (low‐grade dysplasia).
11
11
Forest plot ‐ Precancerous or cancerous (intermediate‐ or high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐grade dysplasia).
12
12
Forest plot of 33 Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) or benign ‐ EUS.
13
13
Forest plot ‐ Cystic lesion subgroup analysis: Cancerous versus benign.
14
14
Forest plot ‐ Cystic lesion subgroup analysis: Precancerous or cancerous versus benign ‐ EUS‐FNA.
1
1. Test
Cancerous versus benign or precancerous ‐ EUS‐FNA (cytology).
2
2. Test
Cancerous versus benign or precancerous ‐ EUS‐FNA (CEA > 500 ng/mL).
3
3. Test
Cancerous versus benign or precancerous ‐ PET.
4
4. Test
Cancerous versus benign ‐ EUS.
5
5. Test
Cancerous versus benign ‐ EUS‐FNA.
6
6. Test
Cancerous versus benign ‐ PET.
7
7. Test
Cancerous versus benign ‐ PET (SUVmax > 3.5).
8
8. Test
Cancerous versus benign ‐ CT.
9
9. Test
Cancerous versus benign ‐ MRI.
10
10. Test
Precancerous or cancerous versus benign ‐ EUS.
11
11. Test
Precancerous or cancerous versus benign ‐ EUS‐FNA.
12
12. Test
Precancerous or cancerous versus benign ‐ EUS‐FNA (CEA > 50 ng/mL).
13
13. Test
Precancerous or cancerous versus benign ‐ PET (SUVmax > 2.4).
14
14. Test
Precancerous or cancerous versus benign ‐ CT.
15
15. Test
Precancerous or cancerous versus benign ‐ MRI.
16
16. Test
Cancerous (invasive carcinoma) versus precancerous (dysplasia) ‐ EUS.
17
17. Test
Cancerous (invasive carcinoma) versus precancerous (dysplasia) ‐ EUS‐FNA.
18
18. Test
Cancerous (invasive carcinoma) versus precancerous (dysplasia) ‐ EUS‐FNA (CEA > 200 ng/mL).
19
19. Test
Cancerous (invasive carcinoma) versus precancerous (dysplasia) ‐ CT.
20
20. Test
Cancerous (invasive carcinoma) versus precancerous (dysplasia) ‐ MRI.
21
21. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ EUS.
22
22. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ EUS‐FNA.
23
23. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ EUS‐FNA (CEA > 200 ng/mL).
24
24. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ EUS‐FNA (CA 19‐9 > 1000 U/mL).
25
25. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ EUS‐FNA (CEA > 692.8 ng/mL).
26
26. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ PET (SUVmax 2 to 2.5).
27
27. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ CT.
28
28. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) ‐ MRI.
29
29. Test
Cancerous (invasive carcinoma) versus precancerous (low‐grade dysplasia) ‐ EUS.
30
30. Test
Cancerous (invasive carcinoma) versus precancerous (low‐grade dysplasia) ‐ CT.
31
31. Test
Precancerous or cancerous (intermediate‐ or high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐grade dysplasia) ‐ CT.
32
32. Test
Precancerous or cancerous (intermediate‐ or high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐grade dysplasia) ‐ MRI.
33
33. Test
Cancerous (high‐grade dysplasia or invasive carcinoma) versus precancerous (low‐ or intermediate‐grade dysplasia) or benign ‐ EUS.
34
34. Test
Cystic lesion subgroup analysis ‐ Cancerous versus benign ‐ EUS‐FNA.
35
35. Test
Cystic lesion subgroup analysis ‐ Cancerous versus benign ‐ PET.
36
36. Test
Cystic lesion subgroup analysis ‐ Precancerous or cancerous versus benign ‐ EUS‐FNA.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Sedlack 2002 {published data only}
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    1. Tomimaru Y, Takeda Y, Tatsumi M, Kim T, Kobayashi S, Marubashii S, et al. Utility of 2‐[f‐18] fluoro‐2‐deoxy‐d‐glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary‐mucinous neoplasm of the pancreas. Oncology Reports 2010;24(3):613‐20. - PubMed
Yamao 2001 {published data only}
    1. Yamao K, Ohashi K, Nakamura T, Suzuki T, Watanabe Y, Shimizu Y, et al. Evaluation of various imaging methods in the differential diagnosis of intraductal papillary‐mucinous tumor (IPMT) of the pancreas. Hepato‐Gastroenterology 2001;48(40):962‐6. - PubMed
Zhan 2011 {published data only}
    1. Zhan XB, Xie B, Ma D, Li ZS. Value of endoscopic ultrasonographic features in predicting the malignancy of pancreatic mucinous cystic neoplasms and intraductal papillary mucinous neoplasms. Gut 2011;60:A202.
Zhan 2013 {published data only}
    1. Zhan XB, Wang B, Liu F, Ye XF, Jin ZD, Li ZS. Cyst fluid carcinoembryonic antigen concentration and cytology by endosonography‐guided fine needle aspiration in predicting malignant pancreatic mucinous cystic neoplasms. Journal of Digestive Diseases 2013;14(4):191‐5. - PubMed

References to studies excluded from this review

Aburime 2014 {published data only}
    1. Aburime E, Jafri M, Afzal A, Gress FG. Use of real time EUS elastography in targeting EUS‐FNA biopsy of suspicious pancreatic masses: A pilot study. Gastrointestinal Endoscopy 2014;1:AB333.
Adamek 2000 {published data only}
    1. Adamek HE, Albert J, Breer H, Weitz M, Schilling D, Riemann JF. Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: A prospective controlled study. Lancet 2000;356(9225):190‐3. - PubMed
Adimoolam 2011 {published data only}
    1. Adimoolam V, Sanchez MJ, Siddiqui UD, Yu S, Dzuira JD, Padda MS, et al. Endoscopic ultrasound identifies synchronous pancreas cystic lesions not seen on initial cross‐sectional imaging. Pancreas 2011;40(7):1070‐2. - PubMed
Afify 2003 {published data only}
    1. Afify AM, al‐Khafaji BM, Kim B, Scheiman JM. Endoscopic ultrasound‐guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy. Acta Cytologica 2003;47(3):341‐8. - PubMed
Agarwal 2004 {published data only}
    1. Agarwal B, Abu‐Hamda E, Molke KL, Correa AM, Ho L. Endoscopic ultrasound‐guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. American Journal of Gastroenterology 2004;99(5):844‐50. - PubMed
Agarwal 2008a {published data only}
    1. Agarwal B, Krishna NB, Labundy JL, Safdar R, Akduman EI. EUS and/or EUS‐guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointestinal Endoscopy 2008;68(2):237‐42. - PubMed
Agarwal 2008b {published data only}
    1. Agarwal B, Ludwig OJ, Collins BT, Cortese C. Immunostaining as an adjunct to cytology for diagnosis of pancreatic adenocarcinoma. Clinical Gastroenterology and Hepatology 2008;6(12):1425‐31. - PubMed
Agarwal 2008c {published data only}
    1. Agarwal B, Reddy AV, Labundy JI, Krishna NB. Diagnostic accuracy of EUS/EUS‐FNA for pancreatic cancer in patients with or without associated chronic pancreatitis. Gastrointestinal Endoscopy 2008;67(5):AB213.
Aguilar‐Saavedra 2011 {published data only}
    1. Aguilar‐Saavedra JR, Lentz G, Chalikonda S, Vogt D, Walsh M. Pancreatic serous cystic neoplasms ‐ is size an indication for surgery?. Gastroenterology 2011;140(5 Suppl 1):S1038.
Ahmad 2001 {published data only}
    1. Ahmad NA, Kochman ML, Lewis JD, Ginsberg GG. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas?. American Journal of Gastroenterology 2001;96(12):3295‐300. - PubMed
Ahmad 2003 {published data only}
    1. Ahmad NA, Kochman ML, Brensinger C, Brugge WR, Faigel DO, Gress FG, et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non‐neoplastic pancreatic cystic lesions. Gastrointestinal Endoscopy 2003;58(1):59‐64. - PubMed
Ainsworth 2010 {published data only}
    1. Ainsworth AP, Hansen T, Fristrup CW, Mortensen MB. Indications for and clinical impact of repeat endoscopic ultrasound. Scandinavian Journal of Gastroenterology 2010;45(4):477‐82. - PubMed
Aithal 2001 {published data only}
    1. Aithal GP, Cunningham JT, Kim EY, Wallace MB, Patel RS, Hawes RH, et al. Accuracy of endoscopic ultrasound in suspecting the diagnosis of intraductal papillary mucinous tumor of the pancreas. Gastrointestinal Endoscopy 2001;53(5):AB166. - PubMed
Aithal 2002 {published data only}
    1. Aithal GP, Chen RY, Cunningham JT, Durkalski V, Kim EY, Patel RS, et al. Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas. Gastrointestinal Endoscopy 2002;56(5):701‐7. - PubMed
Akahoshi 1998 {published data only}
    1. Akahoshi K, Chijiiwa Y, Nakano I, Nawata H, Ogawa Y, Tanaka M, et al. Diagnosis and staging of pancreatic cancer by endoscopic ultrasound. British Journal of Radiology 1998;71(845):492‐6. - PubMed
Akwei 2011 {published data only}
    1. Akwei S, Al‐Khyatt W, Malhotra R, Whiting F, Boyce T, Hammouche D, et al. The value of endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration in the diagnosis and assessment of resectability of mass lesions in the head of pancreas. HPB 2011;13:104.
Al‐Haddad 2007 {published data only}
    1. Al‐Haddad M, Raimondo M, Woodward T, Krishna M, Pungpapong S, Noh K, et al. Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: A pilot study. Gastrointestinal Endoscopy 2007;65(6):894‐8. - PubMed
Al‐Haddad 2010a {published data only}
    1. Al‐Haddad M, Hajj II, Eloubeidi MA. Endoscopic ultrasound for the evaluation of cystic lesions of the pancreas. Journal of the Pancreas 2010;11(4):299‐309. - PubMed
Al‐Haddad 2010b {published data only}
    1. Al‐Haddad MA, Dewitt JM, Sherman S, Schmidt CM, Juliar BE, Stuart JS, et al. Diagnostic accuracy of pancreatic cyst fluid tumor markers obtained by EUS‐guided sampling. Gastrointestinal Endoscopy 2010;71(5):AB283.
Al‐Haddad 2014 {published data only}
    1. Al‐Haddad M, Dewitt J, Sherman S, Max Schmidt C, Leblanc JK, McHenry L, et al. Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. Gastrointestinal Endoscopy 2014;79(1):79‐87. - PubMed
Alizadeh 2014 {published data only}
    1. Alizadeh AHM, Hadizadeh M, Padashi M, Shahbaazi S, Molaee M, Shariatpanahi ZV. Comparison of two techniques for endoscopic ultrasonography fine‐needle aspiration in solid pancreatic mass. Endoscopic Ultrasound 2014;3(3):174‐8. - PMC - PubMed
Al‐Jebreen 2004 {published data only}
    1. Al‐Jebreen AM, Perini R, Sutherland F, Romagnuolo J. Accuracy of endoscopic ultrasound, fine needle aspiration, cytology, and cyst fluid tumor markers in patients with pancreatic cystic lesions: Comparison with surgical pathology and 12‐month follow‐up. Gastrointestinal Endoscopy 2004;59(5):P232.
Aljebreen 2007 {published data only}
    1. Aljebreen AM, Romagnuolo J, Perini R, Sutherland F. Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19‐9 levels in pancreatic cystic lesions. World Journal of Gastroenterology 2007;13(29):3962‐6. - PMC - PubMed
Al‐Najami 2015 {published data only}
    1. Al‐Najami I, Ainsworth AP. Endoscopic ultrasonography is a valuable diagnostic tool in patients with incidental findings in the pancreas or bile ducts. Danish Medical Journal 2015;62(3):A5039. - PubMed
Alsohaibani 2008 {published data only}
    1. Alsohaibani F, Bigam D, Kneteman N, Shapiro AMJ, Sandha GS. The impact of preoperative endoscopic ultrasound on the surgical management of pancreatic neuroendocrine tumours. Canadian Journal of Gastroenterology 2008;22(10):817‐20. - PMC - PubMed
Alsohaibani 2009 {published data only}
    1. Alsohaibani F, Girgis S, Sandha GS. Does onsite cytotechnology evaluation improve the accuracy of endoscopic ultrasound‐guided fine‐needle aspiration biopsy?. Canadian Journal of Gastroenterology 2009;23(1):26‐30. - PMC - PubMed
Alston 2014 {published data only}
    1. Alston E, Bae S, Eltoum IA. Atypical cytologic diagnostic category in EUS‐FNA of the pancreas: Follow‐up, outcomes, and predictive models. Cancer Cytopathology 2014;122(6):428‐34. - PubMed
Amin 2006 {published data only}
    1. Amin Z, Theis B, Russell RC, House C, Novelli M, Lees WR. Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT. Clinical Radiology 2006;61(12):996‐1002. - PubMed
Andersen 1994 {published data only}
    1. Andersen HB, Pihl HE, Tjalve E, Burcharth F. CT diagnosis of pancreatic or periampullary cancer. Ugeskrift for Laeger 1994;156(50):7534‐7. - PubMed
Antonini 2015 {published data only}
    1. Antonini F, Belfiori V, Minicis S, Lo Cascio M, Marraccini B, Piergallini S, et al. Is "wet suction" technique useful to improve the diagnostic accuracy of endoscopic ultrasound guided fine‐needle biopsy of pancreatic masses without rapid on‐site cytologic evaluation? Preliminary results of a comparative study. Digestive and Liver Disease 2015;47(Suppl 2):e149.
Arabul 2012 {published data only}
    1. Arabul M, Karakus F, Alper E, Kandemir A, Celik M, Karakus V, et al. Comparison of multidetector CT and endoscopic ultrasonography in malignant pancreatic mass lesions. Hepato‐Gastroenterology 2012;59(117):1599‐603. - PubMed
Ardengh 2007a {published data only}
    1. Ardengh JC, Lopes CV, Campos AD, Pereira de Lima LF, Venco F, Modena JL. Endoscopic ultrasound and fine needle aspiration in chronic pancreatitis: Differential diagnosis between pseudotumoral masses and pancreatic cancer. JOP: Journal of the Pancreas [Electronic Resource] 2007;8(4):413‐21. - PubMed
Ardengh 2007b {published data only}
    1. Ardengh JC, Lopes CV, Lima LF, Oliveira JR, Venco F, Santo GC, et al. Diagnosis of pancreatic tumors by endoscopic ultrasound‐guided fine‐needle aspiration. World Journal of Gastroenterology 2007;13(22):3112‐6. - PMC - PubMed
Ardengh 2008a {published data only}
    1. Ardengh JC, Lopes CV, Lima LF, Venco F, Santo GC, Begnami MD, et al. Cell block technique and cytological smears for the differential diagnosis of pancreatic neoplasms after endosonography‐guided fine‐needle aspiration. Acta Gastroenterologica Latinoamericana 2008;38(4):246‐51. - PubMed
Ardengh 2008b {published data only}
    1. Ardengh JC, Paulo GA, Nakao FS, Venco F, Santo GC, Geocze S. Endoscopic ultrasound guided fine‐needle aspiration core biopsy: Comparison between an automatic biopsy device and two conventional needle systems. Acta Gastroenterologica Latinoamericana 2008;38(2):105‐15. - PubMed
Ardengh 2013 {published data only}
    1. Ardengh JC, Lopes CV, Kemp R, Venco F, Lima‐Filho ER, dos Santos JS. Accuracy of endoscopic ultrasound‐guided fine‐needle aspiration in the suspicion of pancreatic metastases. BMC Gastroenterology 2013;13:63. - PMC - PubMed
Argimak 2009 {published data only}
    1. Argimak Y, Temizoz O, Tosun A, Cakir B. Evaluation of pancreatic malign tumours with mangafodipir trisodium. Trakya Universitesi Tip Fakultesi Dergisi 2009;26(1):53‐8.
Arikawa 2007 {published data only}
    1. Arikawa S, Uchida M, Shinagawa M, Uozumi J, Hayabuchi N, Okabe Y, et al. The role of multi‐detector‐row computed tomograph in the diagnosis of intraductal papillary‐mucinous tumors of the pancreas in comparison to endoscopic retrograde pancreatography, endoscopic ultrasonography, magnetic resonance cholangiopancreatography. Nippon Shokakibyo Gakkai Zasshi ‐ Japanese Journal of Gastroenterology 2007;104(3):373‐80. - PubMed
Arlt 2013 {published data only}
    1. Arlt A, Ellrichmann M, Schreiber S, Monig H. Diagnosis and differential diagnosis of panceatic lesions. Deutsche Medizinische Wochenschrift 2013;138(49):2539‐42. - PubMed
Asagi 2013 {published data only}
    1. Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R, et al. Utility of contrast‐enhanced FDG‐PET/CT in the clinical management of pancreatic cancer: Impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. Pancreas 2013;42(1):11‐9. - PubMed
Aslanian 2011 {published data only}
    1. Aslanian HR, Estrada JD, Rossi F, Dziura J, Jamidar PA, Siddiqui UD. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography for obstructing pancreas head masses: Combined or separate procedures?. Journal of Clinical Gastroenterology 2011;45(8):711‐3. - PubMed
Asnacios 2003 {published data only}
    1. Asnacios A, Buscail L, Selves J, Nogueira E, Fourtanier G, Suc B, et al. Predictive diagnostic value of endoscopic ultrasound‐guided fine needle aspiration of unilocular macrocystic lesions of the pancreas. Gastroenterology 2003;124(4):A440.
Atef 2013 {published data only}
    1. Atef E, Nakeeb A, Hanafy E, Hemaly M, Hamdy E, El‐Geidie A. Pancreatic cystic neoplasms: Predictors of malignant behavior and management. Saudi Journal of Gastroenterology 2013;19(1):45‐53. - PMC - PubMed
Attasaranya 2007 {published data only}
    1. Attasaranya S, Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound‐guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP: Journal of the Pancreas [Electronic Resource] 2007;8(5):553‐63. - PubMed
Awadallah 2008 {published data only}
    1. Awadallah NS, Shroyer KR, Langer DA, Torkko KC, Chen YK, Bentz JS, et al. Detection of b7‐h4 and p53 in pancreatic cancer: Potential role as a cytological diagnostic adjunct. Pancreas 2008;36(2):200‐6. - PubMed
Azizi 2014 {published data only}
    1. Azizi A, Kumbhari V, Gill R, Pavey D, Leong RWL, Merrett N, et al. Diagnostic yield of surepath in solid pancreatic and gist lesions. Journal of Gastroenterology and Hepatology 2014;29(Suppl S2):48.
Baba 2004 {published data only}
    1. Baba T, Yamaguchi T, Ishihara T, Kobayashi A, Oshima T, Sakaue N, et al. Distinguishing benign from malignant intraductal papillary mucinous tumors of the pancreas by imaging techniques. Pancreas 2004;29(3):212‐7. - PubMed
Baek 2015 {published data only}
    1. Baek HW, Park MJ, Rhee YY, Lee KB, Kim MA, Park IA. Diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration cytology of pancreatic lesions. Journal of Pathology & Translational Medicine 2015;49(1):52‐60. - PMC - PubMed
Baghbanian 2012 {published data only}
    1. Baghbanian M, Shabazkhani B, Ghofrani H, Forutan H, Dariani N, Farahvash M, et al. Efficacy of endoscopic ultrasound guided fine needle aspiration in patients with solid pancreatic neoplasms. Saudi Journal of Gastroenterology 2012;18(6):358‐63. - PMC - PubMed
Baiocchi 2008 {published data only}
    1. Baiocchi GL, Portolani N, Bertagna F, Gheza F, Pizzocaro C, Giubbini R, et al. Possible additional value of 18FDG‐PET in managing pancreas intraductal papillary mucinous neoplasms: Preliminary results. Journal of Experimental and Clinical Cancer Research 2008;27(1):10. - PMC - PubMed
Baiocchi 2010 {published data only}
    1. Baiocchi GL, Portolani N, Missale G, Baronchelli C, Gheza F, Cantu M, et al. Intraductal papillary mucinous neoplasm of the pancreas (IPMN): Clinico‐pathological correlations and surgical indications. World Journal of Surgical Oncology 2010;8:25. - PMC - PubMed
Baiocchi 2012 {published data only}
    1. Baiocchi GL, Bertagna F, Gheza F, Grazioli L, Calanducci D, Giubbini R, et al. Searching for indicators of malignancy in pancreatic intraductal papillary mucinous neoplasms: the value of 18FDG‐PET confirmed. Annals of Surgical Oncology 2012;19(11):3574‐80. - PubMed
Bali 2011 {published data only}
    1. Bali MA, Metens T, Denolin V, Delhaye M, Demetter P, Closset J, et al. Tumoral and nontumoral pancreas: Correlation between quantitative dynamic contrast‐enhanced MR imaging and histopathologic parameters. Radiology 2011;261(2):456‐66. - PubMed
Bang 2012a {published data only}
    1. Bang JY, Hebert‐Magee S, Trevino J, Ramesh J, Varadarajulu S. Randomized trial comparing the 22‐gauge aspiration and 22‐gauge biopsy needles for EUS‐guided sampling of solid pancreatic mass lesions. Gastrointestinal Endoscopy 2012;76(2):321‐7. - PMC - PubMed
Bang 2012b {published data only}
    1. Bang JY, Trevino J, Ramesh J, Varadarajulu S. Randomized trial comparing the fanning and standard techniques for EUS‐guided FNA of solid pancreatic mass lesions. Gastrointestinal Endoscopy 2012;1:AB445‐6. - PMC - PubMed
Bang 2013a {published data only}
    1. Bang JY, Magee SH, Ramesh J, Trevino JM, Varadarajulu S. Randomized trial comparing fanning with standard technique for endoscopic ultrasound‐guided fine needle aspiration of solid pancreatic mass lesions. Journal of Digestive Endoscopy 2013;4(2):55‐6. - PMC - PubMed
Bang 2013b {published data only}
    1. Bang JY, Magee SH, Ramesh J, Trevino JM, Varadarajulu S. Randomized trial comparing fanning with standard technique for endoscopic ultrasound‐guided fine‐needle aspiration of solid pancreatic mass lesions. Endoscopy 2013;45(6):445‐50. - PMC - PubMed
Bang 2015 {published data only}
    1. Bang JY, Krall K, Hebert‐Magee S, Hasan MK, Navaneethan U, Hawes R, et al. Needle changes during EUS‐FNA: An attempt to improve outcomes. Gastrointestinal Endoscopy 2015;1:AB431.
Barber 2011 {published data only}
    1. Barber TW, Kalff V, Cherk MH, Yap KSK, Evans P, Kelly MJ. 18f‐FDG PET/CT influences management in patients with known or suspected pancreatic cancer. Internal Medicine Journal 2011;41(11):776‐83. - PubMed
Bares 1994 {published data only}
    1. Bares R, Klever P, Hauptmann S, Hellwig D, Fass J, Cremerius U, et al. F‐18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 1994;192(1):79‐86. - PubMed
Barkin 1977 {published data only}
    1. Barkin J, Vining D, Miale A, Gottlieb S, Redlhammer DE, Kalser MH. Computerized tomography, diagnostic ultrasound, and radionuclide scanning ‐ comparison of efficacy in diagnosis of pancreatic carcinoma. JAMA 1977;238(19):2040‐2. - PubMed
Baron 1997 {published data only}
    1. Baron PL, Aabakken LE, Cole DJ, LeVeen MB, Baron LF, Daniel DM, et al. Differentiation of benign from malignant pancreatic masses by endoscopic ultrasound. Annals of Surgical Oncology 1997;4(8):639‐43. - PubMed
Barral 2013a {published data only}
    1. Barral M, Sebbag‐Sfez D, Hoeffel C, Chaput U, Dohan A, Eveno C, et al. Characterization of focal pancreatic lesions by the measurement of apparent diffusion coefficient in MRI 1.5 Tesla: Preliminary experience. Journal De Radiologie Diagnostique Et Interventionnelle 2013;94(6):636‐44. - PubMed
Barral 2013b {published data only}
    1. Barral M, Sebbag‐Sfez D, Hoeffel C, Chaput U, Dohan A, Eveno C, et al. Characterization of focal pancreatic lesions using normalized apparent diffusion coefficient at 1.5‐Tesla: Preliminary experience. Diagnostic and Interventional Imaging 2013;94(6):619‐27. - PubMed
Barresi 2014 {published data only}
    1. Barresi L, Tarantino I, Traina M, Granata A, Curcio G, Azzopardi N, et al. Endoscopic ultrasound‐guided fine needle aspiration and biopsy using a 22‐gauge needle with side fenestration in pancreatic cystic lesions. Digestive & Liver Disease 2014;46(1):45‐50. - PubMed
Barron 2014 {published data only}
    1. Barron MR, Roch AM, Waters JA, Parikh JA, DeWitt JM, Al‐Haddad MA, et al. Does preoperative cross‐sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?. Journal of Gastrointestinal Surgery 2014;18(3):447‐55; discussion 455‐6. - PubMed
Bartsch 1998 {published data only}
    1. Bartsch D, Bastian D, Barth P, Schudy A, Nies C, Kisker O, et al. K‐ras oncogene mutations indicate malignancy in cystic tumors of the pancreas. Annals of Surgery 1998;228(1):79‐86. - PMC - PubMed
Basir 2003 {published data only}
    1. Basir Z, Pello N, Dayer AM, Shidham VB, Komorowski RA. Accuracy of cytologic interpretation of pancreatic neoplasms by fine needle aspiration and pancreatic duct brushings. Acta Cytologica 2003;47(5):733‐8. - PubMed
Bassi 2003 {published data only}
    1. Bassi C, Salvia R, Molinari E, Biasutti C, Falconi M, Pederzoli P. Management of 100 consecutive cases of pancreatic serous cystadenoma: Wait for symptoms and see at imaging or vice versa?. World Journal of Surgery 2003;27(3):319‐23. - PubMed
Beal 2015a {published data only}
    1. Beal H, Shea JE, Witt B, Adler DG, Mulvihill SJ, Downs‐Kelly E, et al. Accuracy of diagnosing pancreatic ductal adenocarcinoma by EUS‐FNA at a single institution. Journal of Clinical Oncology 2015;33(3 Suppl):258.
Beal 2015b {published data only}
    1. Beal HL, Shea JE, Witt BL, Adler DG, Mulvihill SJ, Downs‐Kelly E, et al. Accuracy of diagnosing PDA, neuroendocrine tumors, and IPMN by EUS‐FNA at a single institution. Journal of Gastroenterology and Hepatology Research 2015;4(12):1844‐9.
Becker 2001 {published data only}
    1. Becker D, Strobel D, Bernatik T, Hahn EG. Echo‐enhanced color‐ and power‐doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma. Gastrointestinal Endoscopy 2001;53(7):784‐9. - PubMed
Beliao 2012 {published data only}
    1. Beliao S, Ferreira A, Vierasu I, Blocklet D, Goldman S, Metens T, et al. MR imaging versus PET/CT for evaluation of pancreatic lesions. European Journal of Radiology 2012;81(10):2527‐32. - PubMed
Bentz 1998 {published data only}
    1. Bentz JS, Kochman ML, Faigel DO, Ginsberg GG, Smith DB, Gupta PK. Endoscopic ultrasound‐guided real‐time fine‐needle aspiration: Clinicopathologic features of 60 patients. Diagnostic Cytopathology 1998;18(2):98‐109. - PubMed
Bergeron 2015 {published data only}
    1. Bergeron JP, Perry KD, Houser PM, Yang J. Endoscopic ultrasound‐guided pancreatic fine‐needle aspiration: Potential pitfalls in one institution's experience of 1212 procedures. Cancer Cytopathology 2015;123(2):98‐107. - PubMed
Bernstein 2013 {published data only}
    1. Bernstein GR, Jin DX, Fontaine NN, Shah PM, Chandrasekhara V, Kochman ML, et al. Pancreatic cyst size does not have an impact on diagnostic yield of endosonographic ultrasound‐guided fine needle aspiration. Gastrointestinal Endoscopy 2013;1:AB408.
Berzosa 2015 {published data only}
    1. Berzosa M, Villa N, El‐Serag HB, Sejpal, Patel KV. Comparison of endoscopic ultrasound guided 22‐gauge core needle with standard 25‐gauge fine‐needle aspiration for diagnosing solid pancreatic lesions. Endoscopic Ultrasound 2015;4(1):28‐33. - PMC - PubMed
Bhutani 1995 {published data only}
    1. Bhutani M, Hoffman B, Vanvelse A, Sanderscliette A, Hawes R. Endoscopic ultrasound (EUS) guided fine‐needle aspiration (FNA) of malignant pancreatic lesions ‐ accuracy, safety and clinical utility. Gastrointestinal Endoscopy 1995;41(4):298.
Bhutani 1997 {published data only}
    1. Bhutani MS, Hawes RH, Baron PL, Sanders‐Cliette A, Velse A, Osborne JF, et al. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy 1997;29(9):854‐8. - PubMed
Bick 2015 {published data only}
    1. Bick BL, Enders FT, Levy MJ, Zhang L, Henry MR, Dayyeh BKA, et al. The string sign for diagnosis of mucinous pancreatic cysts. Endoscopy 2015;47(7):626‐31. - PubMed
Bighi 1989 {published data only}
    1. Bighi S, Cervi P, Lupi L, Cardona P, Zappi M, Trevisani L. The diagnostic significance of computer tomography in pancreas cancer: 3‐year experience. Italian Current Radiology 1989;8(4):249‐52.
Binmoeller 1998a {published data only}
    1. Binmoeller KF, Brand B, Thul R, Rathod V, Soehendra N. EUS‐guided, fine‐needle aspiration biopsy using a new mechanical scanning puncture echoendoscope. Gastrointestinal Endoscopy 1998;47(5):335‐40. - PubMed
Binmoeller 1998b {published data only}
    1. Binmoeller KF, Thul R, Rathod V, Henke P, Brand B, Jabusch HC, et al. Endoscopic ultrasound‐guided, 18‐gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointestinal Endoscopy 1998;47(2):121‐7. - PubMed
Bluen 2012 {published data only}
    1. Bluen BE, Lachter J, Khamaysi I, Kamal Y, Malkin L, Keren R, et al. Accuracy and quality assessment of EUS‐FNA: A single‐center large cohort of biopsies. Diagnostic & Therapeutic Endoscopy 2012;2012:139563. - PMC - PubMed
Bournet 2007 {published data only}
    1. Bournet B, Souque A, Barthet M, Senesse P, Lesavre N, O'Toole D, et al. Diagnostic performances of oncogene k‐ras mutation analysis coupled to fine needle aspiration biopsy under endoscopic ultrasound (EUS‐FNA) for the diagnosis of solid pancreatic masses: A French multicenter prospective study. Gastroenterology 2007;132(4 Suppl 2):A690‐A.
Bournet 2009 {published data only}
    1. Bournet B, Souque A, Senesse P, Assenat E, Barthet M, Lesavre N, et al. Endoscopic ultrasound‐guided fine‐needle aspiration biopsy coupled with kras mutation assay to distinguish pancreatic cancer from pseudotumoral chronic pancreatitis. Endoscopy 2009;41(6):552‐7. - PubMed
Bournet 2012 {published data only}
    1. Bournet B, Pointreau A, Souque A, Oumouhou N, Muscari F, Lepage B, et al. Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound‐guided fine needle aspiration samples. Pancreatology 2012;12(1):27‐34. - PubMed
Bournet 2015 {published data only}
    1. Bournet B, Selves J, Grand D, Danjoux M, Hanoun N, Cordelier P, et al. Endoscopic ultrasound‐guided fine‐needle aspiration biopsy coupled with a kras mutation assay using allelic discrimination improves the diagnosis of pancreatic cancer. Journal of Clinical Gastroenterology 2015;49(1):50‐6. - PubMed
Boutros 2010 {published data only}
    1. Boutros C, Genova E, Haniff M, Toubia N, Somasundar P, Espast NJ. Single institution experience of 215 patients comparing accuracy of endoscopic ultrasound with subsequent pancreatic surgery. HPB 2010;12:413‐4.
Brand 2002 {published data only}
    1. Brand B, Ponnudurai R, Ryozawa S, Mendes KL, Yang AM, Bohnacker S, et al. A new radial mechanical puncture echoendoscope: Prospective comparison with standard linear and radial echoendoscopes in assessment of focal pancreatic lesions. Gastrointestinal Endoscopy 2002;55(2):249‐54. - PubMed
Brand 2014 {published data only}
    1. Brand RE, Adai AT, Centeno BA, Lee LS, Rateb G, Vignesh S, et al. A microRNA‐based test improves endoscopic ultrasound‐guided cytologic diagnosis of pancreatic cancer. Clinical Gastroenterology and Hepatology 2014;12(10):1717‐23. - PubMed
Brenin 1995 {published data only}
    1. Brenin DR, Talamonti MS, Yang EY, Sener SF, Haines GK, Joehl RJ, et al. Cystic neoplasms of the pancreas. A clinicopathologic study, including DNA flow cytometry. Archives of Surgery 1995;130(10):1048‐54. - PubMed
Brimiene 2011 {published data only}
    1. Brimiene V, Brimas G, Strupas K. Differential diagnosis between chronic pancreatitis and pancreatic cancer: A prospective study of 156 patients. Medicina (Kaunas, Lithuania) 2011;47(3):154‐62. - PubMed
Brugge 2000 {published data only}
    1. Brugge WR. The role of EUS in the diagnosis of cystic lesions of the pancreas. Gastrointestinal Endoscopy 2000;52(6):S18‐22. - PubMed
Brugge 2004a {published data only}
    1. Brugge WR. Evaluation of pancreatic cystic lesions with EUS. Gastrointestinal Endoscopy 2004;59(6):698‐707. - PubMed
Brugge 2004b {published data only}
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Caglar 2013 {published data only}
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Carbognin 2006 {published data only}
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Casneuf 2007 {published data only}
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Cermak 2012 {published data only}
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    1. Chang YH, Sang SL, Tae JS, Moon SH, Lee D, Do HP, et al. Endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of pancreatic and peripancreatic lesions: A single center experience in Korea. Gut & Liver 2009;3(2):116‐21. - PMC - PubMed
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Chen 2007 {published data only}
    1. Chen GE, Bai L, Long Y, Yang G, Dang YT, Li L. Diagnosis value of pathological changes in the pancreas under computed tomography guidance after skin puncture. World Chinese Journal of Digestology 2007;15(24):2657‐9.
Chen 2014 {published data only}
    1. Chen S, Lin J, Wang X, Wu HH, Cramer H. EUS‐guided FNA cytology of pancreatic neuroendocrine tumour (PanNET): A retrospective study of 132 cases over an 18‐year period in a single institution. Cytopathology 2014;25(6):396‐403. - PubMed
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Cheng 2013 {published data only}
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Chiu 2006 {published data only}
    1. Chiu SS, Lim JH, Lee WJ, Chang KT, Oh DK, Lee KT, et al. Intraductal papillary mucinous tumour of the pancreas: Differentiation of malignancy and benignancy by CT. Clinical Radiology 2006;61(9):776‐83. - PubMed
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Cho 2013 {published data only}
    1. Cho CS, Russ AJ, Loeffler AG, Rettammel RJ, Oudheusden G, Winslow ER, et al. Preoperative classification of pancreatic cystic neoplasms: The clinical significance of diagnostic inaccuracy. Annals of Surgical Oncology 2013;20(9):3112‐9. - PMC - PubMed
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    1. Choi ER, Jang TH, Chung YH, Jang KT, Park SM, Lee JK, et al. A prospective comparison of liquid‐based cytology and traditional smear cytology in pancreatic endoscopic ultrasound‐guided fine needle aspiration. Acta Cytologica 2011;55(5):401‐7. - PubMed
Choi 2013 {published data only}
    1. Choi JH, Lee KH, Kim KM, Shin JU, Lee JK, Lee KT, et al. A prospective, comparative trial to optimize sampling techniques in EUS‐guided FNA of solid pancreatic masses. Gastrointestinal Endoscopy 2013;77(5):745‐51. - PubMed
Choi 2016 {published data only}
    1. Choi TW, Lee JM, Kim JH, Yu MH, Han JK, Choi BI. Comparison of multidetector CT and gadobutrol‐enhanced MR imaging for evaluation of small, solid pancreatic lesions. Korean Journal of Radiology 2016;17(4):509‐21. - PMC - PubMed
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Cocieru 2011 {published data only}
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Collins 2013 {published data only}
    1. Collins BT, Murad FM, Wang JF, Bernadt CT. Rapid on‐site evaluation for endoscopic ultrasound‐guided fine‐needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures. Cancer Cytopathology 2013;121(9):518‐24. - PubMed
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    1. Collins BT, Adhikari LJ, Bernadt CT, Wang JF. Correlation of liver and pancreas endoscopic ultrasonography‐guided fine‐needle aspiration biopsy in patients with a primary pancreatic lesion. Journal of the American Society of Cytopathology 2015;4(2):74‐8. - PubMed
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D'Onofrio 2007 {published data only}
    1. D'Onofrio M, Megibow AJ, Faccioli N, Malago R, Capelli P, Falconi M, et al. Comparison of contrast‐enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses. AJR: American Journal of Roentgenology 2007;189(6):1435‐42. - PubMed
D'Onofrio 2013 {published data only}
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Dadds 2012 {published data only}
    1. Dadds HR, Keane G, Huggett MT, Pereira SP. Utility of EUS‐FNA for identifying (pre‐)malignant pancreatic cysts. Pancreatology 2012;12 (3):e3.
Dani 2000 {published data only}
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Dawwas 2012 {published data only}
    1. Dawwas MF, Taha H, Leeds JS, Nayar MK, Oppong KW. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: A prospective, single‐center study. Gastrointestinal Endoscopy 2012;76(5):953‐61. - PubMed
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de Jong 2011 {published data only}
    1. Jong K, Poley JW, Hooft JE, Visser M, Bruno MJ, Fockens P. Endoscopic ultrasound‐guided fine‐needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: Initial results from a prospective study. Endoscopy 2011;43(7):585‐90. - PubMed
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Deng 2008 {published data only}
    1. Deng HB, Shi JH, Wilkerson M, Meschter S, Dupree W, Lin F. Usefulness of s100p in diagnosis of adenocarcinoma of pancreas on fine‐needle aspiration biopsy specimens. American Journal of Clinical Pathology 2008;129(1):81‐8. - PubMed
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DeWitt 2004 {published data only}
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Eloubeidi 2003a {published data only}
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Eloubeidi 2003b {published data only}
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Eloubeidi 2005 {published data only}
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Eloubeidi 2006a {published data only}
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Eloubeidi 2006b {published data only}
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Eloubeidi 2006c {published data only}
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Eloubeidi 2008b {published data only}
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Eloubeidi 2013 {published data only}
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Horwhat 2004 {published data only}
    1. Horwhat JD, McGrath K, Enns RA, Stiffler H, Branch MS, Baillie J, et al. EUS FNA is more sensitive than CT/US FNA for diagnosing pancreatic malignancy: A randomized controlled trial. Gastrointestinal Endoscopy 2004;59(5):P222.
Horwhat 2006 {published data only}
    1. Horwhat JD, Paulson EK, McGrath K, Branch MS, Baillie J, Tyler D, et al. A randomized comparison of EUS‐guided FNA versus CT or US‐guided FNA for the evaluation of pancreatic mass lesions. Gastrointestinal Endoscopy 2006;63(7):966‐75. - PubMed
Hou 2015 {published data only}
    1. Hou X, Jin Z, Xu C, Zhang M, Zhu J, Jiang F, et al. Contrast‐enhanced harmonic endoscopic ultrasound‐guided fine‐needle aspiration in the diagnosis of solid pancreatic lesions: A retrospective study. PLoS ONE 2015;10(3):e0121236. - PMC - PubMed
Hu 2014 {published data only}
    1. Hu C, Qian HF, Li F, Hu C. Comparison of enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography in the differential diagnosis of benign and malignant intraductal papillary mucinous neoplasms of the pancreas. Acta Academiae Medicinae Sinicae 2014;36(1):98‐101. - PubMed
Huang 2010 {published data only}
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Huang 2011 {published data only}
    1. Huang WC, Sheng J, Chen SY, Lu JP. Differentiation between pancreatic carcinoma and mass‐forming chronic pancreatitis: Usefulness of high b value diffusion‐weighted imaging. Journal of Digestive Diseases 2011;12(5):401‐8. - PubMed
Hunt 2009 {published data only}
    1. Hunt G, Master S, Yang SJ, Savides T. Determining diagnostic yield of EUS‐FNA for solid pancreatic masses at a newly established EUS center. Gastrointestinal Endoscopy 2009;69(2):S244.
Hussain 2009 {published data only}
    1. Hussain T, Salamat A, Farooq MA, Hassan F, Hafeez M. Indications for endoscopic ultrasound and diagnosis on fine‐needle aspiration and cytology. JCPSP: Journal of the College of Physicians and Surgeons Pakistan 2009;19(4):223‐7. - PubMed
Hwang 2009 {published data only}
    1. Hwang CY, Lee SS, Song TJ, Moon SH, Lee D, Park DH, et al. Endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of pancreatic and peripancreatic lesions: A single center experience in Korea. Gut & Liver 2009;3(2):116‐21. - PMC - PubMed
Hwang 2011 {published data only}
    1. Hwang DW, Jang JY, Lim CS, Lee SE, Yoon YS, Ahn YJ, et al. Determination of malignant and invasive predictors in branch duct type intraductal papillary mucinous neoplasms of the pancreas: A suggested scoring formula. Journal of Korean Medical Science 2011;26(6):740‐6. - PMC - PubMed
Ibrahim 2014 {published data only}
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Iftimia 2012 {published data only}
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    1. Iglesias Garcia J, Larino Noia J, Dominguez Munoz JE. Differential diagnosis of solid pancreatic masses by quantitative endoscopic ultrasound elastography (q EUS e): A validation study. Pancreatology 2013;13(4 Suppl 1):e9.
Iglesias‐Garcia 2007 {published data only}
    1. Iglesias‐Garcia J, Dominguez‐Munoz E, Lozano‐Leon A, Abdulkader I, Larino‐Noia J, Antunez J, et al. Impact of endoscopic ultrasound‐guided fine needle biopsy for diagnosis of pancreatic masses. World Journal of Gastroenterology 2007;13(2):289‐93. - PMC - PubMed
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Iglesias‐Garcia 2009a {published data only}
    1. Iglesias‐Garcia J, Lanno J, Dominguez‐Munoz E. Accuracy of second‐generation endoscopic ultrasound (EUS) elastography for the differential diagnosis of solid pancreatic masses: A quantitative analysis of tissue stiffness. Gastroenterology 2009;136(5 Suppl 1):A130.
Iglesias‐Garcia 2009b {published data only}
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Iglesias‐Garcia 2010 {published data only}
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Iguchi 2010 {published data only}
    1. Iguchi H, Oota K, Tanada M, Asagi A, Nasu J, Takeji S, et al. Differential diagnosis of IPMNs (benign or malignant) by contrast‐enhanced PET/CT. Pancreatology 2010;10(Suppl 1):79‐80.
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    1. Ikeura T, Detlefsen S, Zamboni G, Manfredi R, Negrelli R, Amodio A, et al. Retrospective comparison between preoperative diagnosis by international consensus diagnostic criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer. Pancreas 2014;43(5):698‐703. - PubMed
Ikeura 2015a {published data only}
    1. Ikeura T, Takaoka M, Uchida K, Shimatani M, Miyoshi H, Kato K, et al. Fluorescence cytology with 5‐aminolevulinic acid in EUS‐guided FNA as a method for differentiating between malignant and benign lesions. Gastrointestinal Endoscopy 2015;81(6):1457‐62. - PubMed
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    1. Ikeura T, Takaoka M, Uchida K, Shimatani M, Miyoshi H, Okazaki K. Photodynamic diagnosis using 5‐aminolevulinic acid during endoscopic ultrasound‐guided fine needle aspiration for pancreatobiliary lesions. Gastrointestinal Endoscopy 2015;1:AB536.
Imazu 2009 {published data only}
    1. Imazu H, Uchiyama Y, Kakutani H, Ikeda K, Sumiyama K, Kaise M, et al. A prospective comparison of EUS‐guided FNA using 25‐gauge and 22‐gauge needles. Gastroenterology Research & Practice 2009;2009:546390. - PMC - PubMed
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    1. Iordache S, Costache MI, Popescu CF, Streba CT, Cazacu S, Saftoiu A. Clinical impact of EUS elastography followed by contrast‐enhanced EUS in patients with focal pancreatic masses and negative EUS‐guided FNA. Medical Ultrasonography 2016;18(1):18‐24. - PubMed
Ippolito 2015 {published data only}
    1. Ippolito D, Allegranza P, Bonaffini PA, Talei Franzesi C, Leone F, Sironi S. Diagnostic accuracy of 256‐detector row computed tomography in detection and characterization of incidental pancreatic cystic lesions. Gastroenterology Research & Practice 2015;2015:707546. - PMC - PubMed
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Ironside 2010 {published data only}
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Ishigami 2010 {published data only}
    1. Ishigami K, Tajima T, Nishie A, Kakihara D, Fujita N, Asayama Y, et al. Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase. European Journal of Radiology 2010;74(3):e95‐100. - PubMed
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Ishikawa 2010 {published data only}
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Itoh 2005 {published data only}
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Itoi 2005a {published data only}
    1. Itoi T, Itokawa F, Sofuni A, Nakamura K, Tsuchida A, Yamao K, et al. Puncture of solid pancreatic tumors guided by endoscopic ultrasonography: A pilot study series comparing trucut and 19‐gauge and 22‐gauge aspiration needles. Endoscopy 2005;37(4):362‐6. - PubMed
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Itoi 2011 {published data only}
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Itokawa 2011 {published data only}
    1. Itokawa F, Itoi T, Sofuni A, Kurihara T, Tsuchiya T, Ishii K, et al. EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. Journal of Gastroenterology 2011;46(6):843‐53. - PubMed
Iwashita 2013 {published data only}
    1. Iwashita T, Nakai Y, Samarasena JB, Park DH, Zhang Z, Gu M, et al. High single‐pass diagnostic yield of a new 25‐gauge core biopsy needle for EUS‐guided FNA biopsy in solid pancreatic lesions. Gastrointestinal Endoscopy 2013;77(6):909‐15. - PubMed
Iwashita 2015 {published data only}
    1. Iwashita T, Yasuda I, Mukai T, Doi S, Nakashima M, Uemura S, et al. Macroscopic on‐site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS‐guided FNA using a 19‐gauge needle for solid lesions: A single‐center prospective pilot study (MOSE study). Gastrointestinal Endoscopy 2015;81(1):177‐85. - PubMed
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Jani 2008 {published data only}
    1. Jani N, Dewitt J, Eloubeidi M, Varadarajulu S, Appalaneni V, Hoffman B, et al. Endoscopic ultrasound‐guided fine‐needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: A multicenter experience. Endoscopy 2008;40(3):200‐3. - PubMed
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Jayasekeran 2012 {published data only}
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Jeong 2012 {published data only}
    1. Jeong HS, Kim H, Tae Kim J, Han JH, Youn SJ, Chae HB, et al. Comparing liquid based cytology (Cellprep) methods with conventional smear methods for EUS or ERCP cytology of pancreas or bile duct. Journal of Gastroenterology and Hepatology 2012;27:371‐2.
Jhala 2007 {published data only}
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Jing 2009 {published data only}
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Khurana 2012 {published data only}
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    1. Kim JK, Altun E, Elias J Jr, Pamuklar E, Rivero H, Semelka RC. Focal pancreatic mass: Distinction of pancreatic cancer from chronic pancreatitis using gadolinium‐enhanced 3D‐gradient‐echo MRI. Journal of Magnetic Resonance Imaging 2007;26(2):313‐22. - PubMed
Kim 2009 {published data only}
    1. Kim SH, Lim JH, Lee WJ, Lim HK. Macrocystic pancreatic lesions: Differentiation of benign from precancerous and malignant cysts by CT. European Journal of Radiology 2009;71(1):122‐8. - PubMed
Kim 2010 {published data only}
    1. Kim YC, Choi JY, Chung YE, Bang S, Kim MJ, Park MS, et al. Comparison of MRI and endoscopic ultrasound in the characterization of pancreatic cystic lesions. AJR: American Journal of Roentgenology 2010;195(4):947‐52. - PubMed
Kim 2012a {published data only}
    1. Kim JH, Eun HW, Park HJ, Hong SS, Kim YJ. Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. European Journal of Radiology 2012;81(11):2927‐35. - PubMed
Kim 2012b {published data only}
    1. Kim JH, Hong SS, Kim YJ, Kim JK, Eun HW. Intraductal papillary mucinous neoplasm of the pancreas: Differentiate from chronic pancreatits by MR imaging. European Journal of Radiology 2012;81(4):671‐6. - PubMed
Kim 2012c {published data only}
    1. Kim JH, Kim MH, Byun JH, Lee SS, Lee SJ, Park SH, et al. Diagnostic strategy for differentiating autoimmune pancreatitis from pancreatic cancer: Is an endoscopic retrograde pancreatography essential?. Pancreas 2012;41(4):639‐47. - PubMed
Kim 2013a {published data only}
    1. Kim JH, Eun HW, Kim KW, Lee JY, Lee JM, Han JK, et al. Intraductal papillary mucinous neoplasms with associated invasive carcinoma of the pancreas: Imaging findings and diagnostic performance of MDCT for prediction of prognostic factors. AJR: American Journal of Roentgenology 2013;201(3):565‐72. - PubMed
Kim 2013b {published data only}
    1. Kim JH, Lee JM, Park JH, Kim SC, Joo I, Han JK, et al. Solid pancreatic lesions: Characterization by using timing bolus dynamic contrast‐enhanced MR imaging assessment ‐ a preliminary study. Radiology 2013;266(1):185‐96. - PubMed
Kim 2013c {published data only}
    1. Kim TH, Choi KH, Song HS, Kim JW, Jeon BJ. Histology combined with cytology by endoscopic ultrasound‐guided fine needle aspiration for the diagnosis of solid pancreatic mass and intra‐abdominal lymphadenopathy. Gut & Liver 2013;7(5):605‐10. - PMC - PubMed
Kim 2013d {published data only}
    1. Kim YI, Woo SM, Lee WJ, Han SS, Park SJ, Kim TH, et al. Appropriate indications of initial endoscopic ultrasound evaluation for detecting mural nodules in branch duct intraductal papillary mucinous neoplasms of the pancreas. Scandinavian Journal of Gastroenterology 2013;48(5):610‐6. - PubMed
Kim 2014a {published data only}
    1. Kim J, Ryu JK, Park JM, Paik WH, Song BJ, Kim YT, et al. Clinical factors associated with accuracy of EUS‐FNA for pancreatic or peripancreatic solid mass without on‐site cytopathologists. Journal of Gastroenterology and Hepatology 2014;29(4):887‐92. - PubMed
Kim 2014b {published data only}
    1. Kim JH, Lee SJ, Moon SH, Kim HJ, Kim HJ, Song IH, et al. Incremental value of cell block preparations over conventional smears alone in the evaluation of EUS‐FNA for pancreatic masses. Hepato‐Gastroenterology 2014;61(135):2117‐22. - PubMed
Kim 2014c {published data only}
    1. Kim TH, Kim MH, Hwang JH, Yoo KS, Lee WJ, Lee JK, et al. Predictors of malignancy in pure branch duct intraductal papillary mucinous neoplasm of the pancreas: A multicenter study in Korea. Gastroenterology 2014;146(5 Suppl 1):S483‐4.
Kim 2014d {published data only}
    1. Kim YI, Kim SK, Paeng JC, Lee HY. Comparison of f‐18‐FDG PET/CT findings between pancreatic solid pseudopapillary tumor and pancreatic ductal adenocarcinoma. European Journal of Radiology 2014;83(1):231‐5. - PubMed
Kim 2015a {published data only}
    1. Kim JR, Jang JY, Kang MJ, Park T, Lee SY, Jung W, et al. Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19‐9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas. Journal of Hepato‐Biliary‐Pancreatic Sciences 2015;22(9):699‐707. - PubMed
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    1. Kin T, Katanuma A, Yane K, Takahashi K, Osanai M, Takaki R, et al. Diagnostic ability of EUS‐FNA for pancreatic solid lesions with conventional 22‐gauge needle using the slow pull technique: A prospective study. Scandinavian Journal of Gastroenterology 2015;50(7):900‐7. - PubMed
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    1. Klapman JB, Chang KJ, Nguyen PT. The negative predictive value (NPV) of endoscopic ultrasound (EUS) in a large series of patients with suspected pancreatic cancer. Gastrointestinal Endoscopy 2004;59(5):P223.
Klapman 2005 {published data only}
    1. Klapman JB, Chang KJ, Lee JG, Nguyen P. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. American Journal of Gastroenterology 2005;100(12):2658‐61. - PubMed
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    1. Kliment M, Urban O, Cegan M, Fojtik P, Falt P, Dvorackova J, et al. Endoscopic ultrasound‐guided fine needle aspiration of pancreatic masses: The utility and impact on management of patients. Scandinavian Journal of Gastroenterology 2010;45(11):1372‐9. - PubMed
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    1. Kliment M, Urban O, Lovecek M, Straka M, Ziak D, Falt P, et al. Endosonography‐guided fine needle aspiration biopsy of solid pancreatic masses ‐ accuracy and impact on the treatment of 358 patients. Gastroenterologie a Hepatologie 2013;67(5):431‐7.
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    1. Kokhanenko N, Amosov VI, Nikonchuk NP, Mosiagina SG, Bryzgalova SV, Dundukov NN, et al. Significance of ultrasound examination and computed tomography in the diagnosis of pancreatic cancer. Vestnik Khirurgii Imeni i ‐ i ‐ Grekova 2001;160(5):61‐5. - PubMed
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Korenblit 2016 {published data only}
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Krishna 2009b {published data only}
    1. Krishna NB, LaBundy JL, Saripalli S, Safdar R, Agarwal B. Diagnostic value of EUS‐FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Pancreas 2009;38(6):625‐30. - PubMed
Krishna 2009c {published data only}
    1. Krishna NB, Mehra M, Reddy AV, Agarwal B. EUS/EUS‐FNA for suspected pancreatic cancer: Influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointestinal Endoscopy 2009;70(1):70‐9. - PubMed
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    1. Krishna NB, Tummala P, Mehan CD, Reddy AV, Hartman JA, Agarwal B. Small and potentially resectable focal pancreatic lesions noted on CT/MRI scans in nonjaundiced patients: Likelihood of neoplasia and utility of EUS. Journal of Gastrointestinal Surgery 2012;16(4):793‐800. - PubMed
Krishna 2013 {published data only}
    1. Krishna SG, Bhattacharya A, Ladha HS, Singh A, Ross WA, Bhutani MS, et al. Pretest probability and diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) for pancreatic adenocarcinoma at a tertiary care oncology center: A 12 year experience. Gastrointestinal Endoscopy 2013;77(5 Suppl):AB403.
Krishna 2015 {published data only}
    1. Krishna SG, Li F, Bhattacharya A, Ladha H, Porter K, Singh A, et al. Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: A tertiary oncology center experience. Gastrointestinal Endoscopy 2015;81(2):370‐9. - PubMed
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Lee 2007 {published data only}
    1. Lee H, Jong KL, Seok SK, Choi D, Jang KT, Jeong HK, et al. Is there any clinical or radiologic feature as a preoperative marker for differentiating mass‐forming pancreatitis from early‐stage pancreatic adenocarcinoma?. Hepato‐Gastroenterology 2007;54(79):2134‐40. - PubMed
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