Endoscopic Tissues Sampling of Solid Pancreatic Lesions for Molecular Analysis

Endoscopic ultrasound (EUS)–guided tissue acquisition of solid pancreatic lesions is the diagnostic gold standard for most pancreas lesions. Since this technique was initially developed, there have been several iterations of the device technology and advancements in understanding technique to maximize diagnostic yield while minimizing adverse events. We describe the current literature on techniques for EUS-guided tissue acquisition, including fine-needle biopsy vs fine-needle aspiration, suction vs slow pull, fanning vs torque technique, and the use of rapid onsite cytopathology in obtaining a diagnosis. Additionally, modern medicine has allowed for use of these specimens to guide personalized cancer treatment for patients. Unique to this review, we have included a discussion on next-generation sequencing, organoids, and single-cell analysis and how EUS specimens perform in these novel downstream analyses.