Aims: to provide a comprehensive description of the diagnoses and the results of EUS-TA (adequacy, sensitivity, specificity, and accuracy) for solid pancreatic lesions that have been referred due to clinical and radiological findings in a tertiary oncological referral center.

Methods: a retrospective analysis was conducted on consecutive patients who underwent EUS-FNA or EUS-FNB procedures. These procedures were performed by advanced fellows under direct supervision of expert endoscopists. The material obtained was subsequently analysed by a pathologist specializing in the gastrointestinal tract. However, the pathologist was not in the endoscopy room during the procedure, i.e., without rapid-on-site-evaluation (ROSE). Final diagnosis was based on histology or clinical/radiological follow-up.

Results: From April 2013 to February 2025, a total of 491 EUS pancreatic punctures were conducted on 433 patients, of whom 50.3% were female. The mean age of the patients was 62 years, with a range of 25 to 86 years. The mean size of the lesions was 36 mm, with a range of 2 to 120 mm The majority of lesions were found to be localized in the pancreatic head region (72.7%). The final diagnoses revealed that 70.8% of cases were confirmed to be ductal adenocarcinoma, 9.6% were neuroendocrine tumours, 8.6% were benign lesions, and 4.8% exhibited pancreatic metastases from other organs. Lymphoma was diagnosed in 4 patients (0.8%), while 29 patients had other diagnoses. A total of 85.7% (95% CI 82.3–88.6%) of the samples were deemed adequate. The sensitivity was 84.7% (95% CI 81.0–87.9%), the specificity was 94.3% (95% CI 84.3–98.8%), and the accuracy was 85.7% (95% CI 82.3–88.6%).

Notwithstanding its designation as an oncological referral center, a significant proportion of cases, amounting to nearly 10%, were found to be benign lesions.  Despite the predominance of adenocarcinoma, accounting for over 70% of cases, other rare neoplasms, including neuroendocrine tumors, metastases, and lymphomas, can also be diagnosed through EUS-TA. Given the significant management disparities among neoplasms, histological confirmation is imperative. Current guidelines stipulate that a diagnostic rate of at least 85-87% is a pivotal quality marker for eligible samples in all solid lesions undergoing EUS-TA. The ASGE suggests that a diagnostic rate of 70% should be maintained and a sensitivity of 85% or higher for malignancy on EUS-TA of pancreatic lesions. Our results demonstrated the achievement of these quality indicators even when the procedures were done by fellows and without ROSE. However, the all EUS-TA were supervised by experienced endoscopists and analyzed by expert GI pathologists. Continuous monitoring of quality indicators related to the diagnostic performance of ultrasound-guided biopsy should be carried out by all centers that perform this procedure, aiming to identify potential failures and further improve results.