Systemic chemotherapy can improve disease-related symptoms and/or prolong survival in patients with pancreatic cancer. Before the start of chemotherapy, the diagnosis pancreatic carcinoma must be confirmed by tumor tissue samples, which are often obtained during endoscopic ultrasound (EUS) by fine needle aspiration (FNA) or fine needle biopsy (FNB). Obtaining core biopsies by FNB has several potential benefits, such as making a more reliable diagnosis, performing immunohistochemistry for diagnostic reasons and in the future obtaining enough malignant cells to deliver personalized based chemotherapy regimen based on mutations detected by next generation sequencing. Obtaining high quality and sufficient tumor material is essential for genomic profiling with a preference of FNB over FNA. Up to now, no specific FNB needle has been found to be superior in diagnostic accuracy and in obtaining tissue for genomic profiling. In this study, we aim to evaluate the diagnostic accuracy of a new FNB needle (Micro-Tech Europe GmbH, Düsseldorf, Germany) and we study the adequacy of the obtained tissue samples for performing genetic sequencing.

This study is an international multicenter prospective cohort study. The study will be performed in collaboration with the disciplines of Gastroenterology and Pathology of the participating hospitals.

Inclusion Criteria:

• 18 years and older
• Clinical suspicion of pancreatic adenocarcinoma
• Indication for obtaining EUS-guided histology of a suspected pancreatic lesion
• Written informed consent

Exclusion Criteria:

• Contra-indications to undergoing an EUS (e.g., oropharyngeal abnormalities)
• Altered anatomy (e.g., after previous Whipple-operation, Roux-and-Y gastrojejunostomy)
• Contra-indications to the administration of benzodiazepines, propophol or opioids
• Pregnancy
• Insufficient knowledge of the Dutch language to be able to understand the patient information

Each patient with clinical suspicion of pancreatic cancer, based on imaging, will be discussed in the multidisciplinary team consultation. When an EUS-FNB is indicated, patients are included if they meet all the inclusion and none of the exclusion criteria.

The population will consist of elderly patients, as pancreatic cancer is rarely diagnosed before the age of 55.

The dataset used during this study is available from the corresponding author upon reasonable request.