Contrast Enhanced EUS for Predicting Solid Pancreatic Neuroendocrine Tumor Grade and Aggressiveness

Pancreatic neuroendocrine tumor (PNET) behavior assessment is a daily challenge for physicians. Modern PNET management varies from a watch-and-wait strategy to surgery depending on tumor aggressiveness. Therefore, the aggressiveness definition plays a pivotal role in the PNET work-up. The aggressiveness of PNETs is mainly based on the dimensions and histological grading, with sometimes a lack of specificity and sensibility. In the last twenty years, EUS has become a cornerstone in the diagnostic phase of PNET management for its high diagnostic yield and the possibility of obtaining a histological specimen. The number of EUS applications in the PNET work-up has been rapidly increasing with new and powerful possibilities. The application of contrast has led to an important step in PNET detection; in recent years, it has been gaining interesting applications in aggressiveness assessment. In this review, we underline the latest experiences and opportunities in the behavior assessment of PNETs using contact-enhanced EUS and contested enhanced harmonic EUS with a particular focus on the future application and possibility that these techniques could provide.

Automated summary

Assessing the behavior of pancreatic neuroendocrine tumors (PNETs) remains a daily challenge for physicians. The definition of aggressiveness is crucial in determining the appropriate management strategy, ranging from observation to surgery. EUS has emerged as a valuable tool in diagnosing PNETs and has experienced rapid advancements in recent years, particularly in the assessment of aggressiveness using contrast-enhanced techniques. This review highlights the latest experiences and opportunities in evaluating PNET behavior with contact-enhanced EUS and contrast-enhanced harmonic EUS, with a focus on future applications and possibilities.