الفهرس 
Acknowledgments
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Abstract
Our prospective study emerged to to assess the accuracy of EUS and EUS -FNA with cytopathological analysis in diagnosis of pancreatic solid lesions over 2 years from June 2015 to June 2017.Three hundred patients were enrolled in the study, 190 patients (63.3%) were males and 110 patients (36.7%) were females, with an age range between 18 and 80 years (mean ± SD: 56.66 ± 8.75) and 189 patients (63%) were between 41 and 60 years old. Based on histopathological evaluation of the pancreatic lesions, malignant lesions were detected in 237 patients (79%) and benign lesions in 63 patients (21%). The most frequent lesion in the study was adenocarcinoma that was found in 216 patients (72%) while the second most commen malignant lesion were neuroendocrine and cholangiocarcinoma, each of them occurred in 6 patients (2%). Other malignant lesions as lymphoma, metastatic lesions and Insulinoma were found in 4 (1.3%), 3 (1%) and 2 (0.7%) patients respectively. It was noticed that both groups of patients either with malignant or benign lesions had insignificant differences as regarding baseline data with exception of, Male sex was higher in malignant lesions and frequency of abdominal pain was higher in benign lesions. Out of 216 patients with adenocarcinoma, 146 patients were males (67.6%). Majority of this patients were above 40 years old where 142 patients (65.7%) were 41- 60 years old and 72 patients (33.3%) were over 60 years old. Ductal adenocarcinoma was present in 94.9% (205/216) patients, while ampullary adenocarcinoma in 4.6% (10/216) patients and only one patient had duodenal adenocarcinoma. Out of the 300 studied patients, 63 patients (21%) had benign lesions; 58 patients (19.3%) had pancreatitis and 5 patients (1.7%) had papillary adenoma. Pancreatitis was the most frequent benign lesion in the current study where it presented in 58 patients (19.3%). Out of those patients, 30 patients (51.7%) were males and 28 patients (48.3%) were females. 31 patients (53.5%) of those patients with pancreatitis were 41- 60 years old, 21 patients (36.2%) were over 60 years old and only 6 patients (10.3%) were 20- 40 years old. chronic non- specific pancreatitis was the most frequent type of pancreatitis, which was found in 52 patients (89.7%), followed by autoimmune in 5 patients (8.6%), and tuberculous pancreatitis occurred only in 1 patient. During EUS examination it was noticed that majority of malignant and benign pancreatic solid lesions presented in pancreatic head (76%),(69.6%), Single (89%),(90.5%) and homogenous (86%),(90.5%) respectively. Regarding the size of pancreatic solid lesions, the majority of malignant lesions (78%) measured 2 cm or more while the majority of benign lesions (71.4%) measured less than 2 cm. The majority of malignant lesions (87.3%) were hypoechoic consistency while the majority of benign lesions (84.1%) were hyperechoic. Calcification was significantly higher in benign lesions (87.3%). Vascular invasion presented in 160 patients and all of them were malignant (67.5%). Regional lymph node were detected in (60%) of malignant lesions and (6.3%) of benign lesions. Our study showed that EUS had 93.25% sensitivity and 90.48% specificity in diagnosing nature of pancreatic solid lesions. Positive Predictive Value (97.36%), Negative Predictive Value (78.08%) and overall Accuracy (92.67%) with area under the curve was 0.92. The EUS-FNA cytopathology markedly increase the specificity to (100%) with slight increase in sensitivity to (95.4%) in diagnosing nature of pancreatic solid lesions. Positive Predictive Value (100%), Negative Predictive Value (85.1%) and overall Accuracy (96.3%) with area under the curve was 0.95. Post-operative histopathological examination was 100% compatible with results of EUS-FNA cytopathological examination. While EUS finding suggestive of pancreatic malignancy were detected in (92.3%).
EUS has an important role in sampling and identification nature of pancreatic solid lesions, especially lesions less than 3cm in which CT and MRI is inconclusive. EUS is an evolving, promising modality in staging of pancreatic cancer particularly in tumor extension and vascular invasion. EUS helps in early detection of pancreatic cancer thus would decrease the morbidity and mortality. EUS-FNA establishes the tumor type with high accuracy and fewer complications, and it is useful for differential diagnosis. EUS tissue diagnosis is strongly recommended in those cases in which oncological therapy is recommended.