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Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a preferred option for acquiring samples from a solid pancreatic lesion [1, 2]. However, inadequate samples will cause a false-negative diagnosis [3]. It is thus imperative to acquire adequate tissue specimens to improve the accuracy of histological examination [4]. As a new ultrasound technique, sound speed correction can quantitatively measure the tissue hardness [5], and it has been applied to differentiate between healthy and diseased tissues. We therefore used sound speed correction to guide performing EUS-FNA (▶Video 1). A 77-year-old man who reported vague epigastric pain 3 months ago was transferred to our department. Computed tomography (CT) showed a solid lesion 5.1 ×3.7 cm in size in the pancreatic neck (▶Fig. 1). The patient decided to undergo EUS-FNA of the pancreatic mass using sound speed correction to determine the character of the pancreatic lesion. EUS (EG-580UT; Fujifilm Corp., Tokyo, Japan) confirmed a solid lesion 4.3 x 3.7 cm in size in the pancreatic neck (▶Fig. 2). After completing the contrast-enhanced EUS and tissue elastography, we determined the optimal insertion region for FNA after measuring the hardness with the sound speed correction (▶Fig. 3). Adequate tissue specimens were acquired after one pass with a 22G EUS fine needle (Boston Scientific, Marlborough, Massachusetts, USA) (▶Fig. 4). The pathological examination found many atypical cells, and immunohistochemistry subsequently indicated the lesion was positive for carcinoembryonic antigen, carbohydrate antigen 19-9, mucoprotein 5AC, and Ki-67 (▶Fig. 5). The solid pancreatic lesion was eventually established as pancreatic cancer. E-Videos

Diagnostic application of sound speed correction for endoscopic ultrasound-guided tissue acquisition of pancreatic mass