What are the benefits of endoscopic ultrasound in the staging of pancreatic cancer

Female patient, 73 years old, with a history of jaundice, epi-gastric pain radiating to the back, and weight loss of 15 kg in three months. She was referred to our hospital with a possible diagnosis of cancer in the head of the pancreas, with evidence of increased pancreatic head and dilatation of intra- and extra-hepatic biliary ducts on abdominal com-puted tomography and magnetic resonance cholangiogra-phy. Due to obstructive jaundice, a retrograde cholangio-pancreatography was performed, showing partial stenosis of the distal common bile duct with dilatation of bile ducts, which was drained by inserting two biliary plastic stents. An endoscopic ultrasound was requested to further study the pancreas and adjacent structures. During the investigation, a hypoechoic heterogeneous lesion measuring 35 x 30 mm and presenting ill-defined margins was seen in the pancreatic head. There were also signs of vascular involvement, with loss of acoustic inter -face with the wall of the portal vein and absence of vas-cular flow (thrombosis). Furthermore, dilatation of the main pancreatic duct (6 mm) in the regions of body and tail of the pancreas upstream to the lesion described abo-ve was observed. Echo-guided punctures were performed in the lesion for histological clarification.