EUS-DFI in Solid Pancreatic Lesions

Endoscopic ultrasound (EUS) is an essential technique for the evaluation of pancreatic lesions. However, conventional B-mode imaging alone is often insufficient to accurately differentiate the various types of solid pancreatic tumors, making tissue acquisition necessary in many cases. Despite the high diagnostic accuracy of EUS-guided sampling, false-negative results may occur and repeated sampling can be required.

Detective Flow Imaging (DFI) is a novel ultrasound technology that enables visualization of microvascularization without the use of contrast agents by detecting low-velocity blood flow while minimizing motion artifacts. Preliminary evidence suggests that DFI may improve lesion characterization, but data regarding its application in solid pancreatic lesions remain limited.

This is a prospective, international, multicenter observational study including adult patients undergoing routine EUS in whom a solid pancreatic lesion is identified. All participants will undergo standard EUS evaluation, EUS-guided DFI assessment, and tissue acquisition according to routine clinical practice. DFI findings will be correlated with the final diagnosis established by surgical pathology, EUS-guided tissue sampling, or comprehensive clinical, imaging, and laboratory follow-up of at least six months.

The primary objective is to characterize DFI microvascularization patterns according to the histological diagnosis of solid pancreatic lesions. Secondary objectives include assessing interobserver agreement among investigators and determining the diagnostic performance of DFI vascular patterns for differentiating malignant from benign pancreatic lesions.

Inclusion criteria

• Adults aged 18 years or older.
• Presence of a solid pancreatic lesion identified during endoscopic ultrasound (EUS), regardless of the indication for the examination.
• Ability and willingness to provide written informed consent.

Exclusion criteria

• Predominantly cystic pancreatic lesions.
• Anatomical abnormalities preventing adequate EUS examination.
• Limited ability to understand the study procedures or provide informed consent.
• Refusal to sign the informed consent form.