The possibility to predict biologic behaviour and outcome by means of molecular biology techniques applied to the EUS-FNA cell sample has also been described. This approach allows to limit the number of false positive findings of the morphologic EUS test alone, which may be due to intra- or peri-pancreatic lymph nodes or splenosis nodules. A methylene blue tattoo can be made with EUS-guided injection on a small NET of the pancreas in order to facilitate intraoperative Inhibitors,research,lifescience,medical localization. Both linear and radial new generation electronic EUS scopes enable application of pulsed colour and power Doppler functions, more recently associated
with the use of ultrasound contrast media. These techniques can help in localization
and differential diagnosis of small hypervascular pancreatic nodules (89). A look in the near future IntraDuctal UltraSound (IDUS) and 3-Dimensional Inhibitors,research,lifescience,medical IDUS will perhaps add something to the already high performances of EUS in diagnosis and staging of biliary and pancreatic diseases (90). A new frontier in diagnosis and therapy could be opened by a new technique, named Endoscopic Ultrasound Retrograde CholangioPancreatography (EURCP) (91), that with some needed technological advances will allow us to put together in the same instrument the diagnostic accuracy of EUS and EUS-FNA with the therapeutic possibilities of ERCP and EUS. With such Inhibitors,research,lifescience,medical an instrument in experienced hands we can predict that the benefits to the patients and the health care system will be substantial. Today EUS is following the same way as endoscopy, i.e., to cross the bridge between a mere diagnostic technique and a therapeutic modality. In this view Inhibitors,research,lifescience,medical EUS can guide or better will guide in the near future a number of therapeutic procedures, such as ablative techniques (92,93), injection therapies (94,95), creation of digestive anastomoses (96,97). Regrettably these
new techniques have progressed very slowly till now for several reasons (small number of operative endosonographers, Inhibitors,research,lifescience,medical very little incentive by manufacturers to put substantial resources Dipeptidyl peptidase into EUS and accessories Everolimus mouse development because the market is too small, the competition of CT, MRI and vascular interventional radiology). Conclusions To date the most accurate imaging techniques for the pancreas remain CE MDHCT and EUS. They provide the most cost-effective and accurate modalities for diagnosis and staging of most cases of pancreatic diseases. CE spiral CT or better MDHCT must today be the initial study of choice in patients with suspected PC. It has replaced digital subtraction angiography for evaluation of vascular infiltration and has similar or higher accuracy than EUS in assessing locoregional extension and vascular involvement. EUS has the highest accuracy in detecting small lesions, in assessing tumor size and lymph nodes involvement.