The diagnosis of pancreatic masses presents a significant clinical challenge due to their malignant potential. Endoscopic Ultrasound (EUS) and Positron Emission Tomography-Computed Tomography (PET-CT) are critical evaluation modalities. This study aimed to evaluate and compare EUS and PET-CT findings in a cohort of patients with pancreatic masses.

Data from 94 consecutive patients evaluated with both EUS and PET-CT between 2020 and 2025 were retrospectively analyzed.

Histopathological examination revealed 84 malignant (89.4%) and 10 benign (10.6%) masses. EUS demonstrated a smaller median mass size in benign lesions (20 mm vs 30 mm; p = 0.005) and showed vascular invasion in 60.7% of malignant cases. PET-CT detected a lower median SUV-max in benign lesions (6 vs 8; p = 0.023). Median CA 19-9 levels were higher in the malignant group (216 U/mL vs 45 U/mL; p = 0.039). The highest diagnostic accuracy was the EUS endosonographic impression, based on ROC analysis. The AUCs (95% CI, p-value) were: EUS impression, 0.744(95% CI: 0.583-0.905, p = 0.002); EUS size, 0.701 (p = 0.011); EUS vascular invasion, 0.647 (p = 0.063); PET-CT qualitative assessment, 0.601 (p = 0.201); and PET-CT SUV-max, 0.568 (p = 0.399). Kaplan-Meier analysis showed that median overall survival for patients with a benign EUS impression (49 months) was significantly longer than for those with a malignant impression (16 months) (log-rank p = 0.001). EUS-detected vascular invasion was associated with shorter median overall survival (6 months vs 24 months in its absence) (log-rank p = 0.001).

These findings underscore the complementary roles of EUS and PET-CT. Integration of clinical information, imaging findings, and biomarker data is essential for optimal diagnosis and management.