Current Role of Endoscopic Ultrasonography in the Early Detection of Pancreatic Cancer: Recognition of Indirect Imaging Findings and Diagnostic Strategy.

Pancreatic cancer remains one of the most lethal malignancies because most patients are diagnosed at an advanced stage. Endoscopic ultrasonography (EUS) has emerged as a key modality for early detection owing to its high spatial resolution and non-invasiveness. In particular, EUS can identify indirect imaging findings associated with pancreatic carcinoma in situ and very early stage pancreatic cancer, including focal main pancreatic duct stenosis, focal pancreatic parenchymal atrophy, periductal hypoechoic changes, and parenchymal heterogeneity, which often precede the formation of detectable masses. EUS also facilitates pathological confirmation through pancreatic juice cytology and tissue sampling. Furthermore, advances in contrast-enhanced imaging, elastography, microvascular imaging, and artificial intelligence have expanded the diagnostic potential of EUS. This review summarizes the current role of EUS in the early detection of pancreatic cancer, focusing on indirect imaging findings, diagnostic strategies, and future perspectives.