<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000200111</article-id>
<article-id pub-id-type="doi">10.1159/000509197</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[The Role of Endoscopic Ultrasound in Pancreatic Cancer Staging in the Era of Neoadjuvant Therapy and Personalised Medicine]]></article-title>
<article-title xml:lang="pt"><![CDATA[O papel da ecoendoscopia no estadiamento do cancro do pâncreas na era da terapêutica neoadjuvante e da medicina personalizada]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bispo]]></surname>
<given-names><![CDATA[Miguel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marques]]></surname>
<given-names><![CDATA[Susana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rio-Tinto]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fidalgo]]></surname>
<given-names><![CDATA[Paulo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Devière]]></surname>
<given-names><![CDATA[Jacques]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Champalimaud Foundation Department of Gastroenterology and Digestive Endoscopy ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Université Libre de Bruxelles Erasmus University Hospital Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology]]></institution>
<addr-line><![CDATA[Brussels ]]></addr-line>
<country>Belgium</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>04</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>04</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>2</numero>
<fpage>111</fpage>
<lpage>120</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000200111&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000200111&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000200111&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Precise staging of pancreatic cancer is crucial for treatment choice. In clinical practice, this includes the TNM staging and determination of tumour resectability, based on a multimodality imaging workup. International guidelines recommend multi-detector computed tomography (CT), with a dedicated pancreatic protocol, as the first-line tool for TNM staging and evaluation of tumour-vessel relationships. In non-metastatic disease upon initial CT assessment, both magnetic resonance imaging and endoscopic ultrasound (EUS) may add relevant information, potentially changing treatment sequence. EUS may have distinct advantages in pancreatic cancer diagnosis and staging when compared with other modalities, being particularly valuable in the determination of portal venous confluence involvement (particularly in small and ill defined/isoattenuating tumours on CT), in locoregional nodal staging and in the detection of ascites. As we step forward to a more frequent use of neoadjuvant chemotherapy and to personalised medicine, the importance of EUS-guided fine-needle biopsy (EUS-FNB) also increases. The recent availability of third-generation biopsy needles significantly increased the diagnostic yield of EUS-guided tissue acquisition, providing diagnostic cell blocks in approximately 95% of cases with only two dedicated passes and allowing ancillary testing, such as immunohistochemistry and molecular profiling of the tumour. In this article, the authors present an updated perspective of the place of EUS and EUS-FNB in the staging algorithm of pancreatic cancer. Data supporting the increasing role of neoadjuvant therapy and the importance of a patient tailored treatment selection, based on tumoural subtyping and molecular profiling, are also discussed.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: No cancro do pâncreas é fundamental um estadiamento preciso para a decisão terapêutica. Na prática clínica, isto inclui o estadiamento TNM e a avaliação da ressecabilidade cirúrgica, baseada numa avaliação imagiológica multimodal. As recomendações de consenso recomendam a tomografia computorizada (TC) multi-detector, com protocolo pancreático, como exame de primeira linha para o estadiamento TNM e determinação de invasão vascular loco-regional. Na doença loco-regional não-metastática (após TC inicial), a ressonância magnética e a ecoendoscopia poderão acrescentar informação relevante, com potencial impacto na decisão terapêutica. A ecoendoscopia apresenta vantagens únicas comparativamente a outros métodos de estadiamento, sendo particularmente útil na avaliação da relação do tumor com a confluência espleno-portal (especialmente na presença de tumores pequenos e isodensos/mal-definidos na TC), no estadiamento ganglionar loco-regional (N) e na detecção de ascite. À medida que caminhamos no sentido da utilização crescente de quimioterapia neoadjuvante e da Medicina personalizada, a relevância da biopsia guiada por ecoendoscopia também aumenta. A recente disponibilização de agulhas de biopsia de terceira geração aumentou significativamente a rentabilidade diagnóstica da punção guiada por ecoendoscopia, obtendo cellblocks para avaliação histológica em cerca de 95% dos casos (com apenas duas passagens), permitindo a realização de estudos ancilares, como avaliação imuno-histoquímica e caracterização molecular do tumor. No presente artigo os autores apresentam uma perspetiva do papel atual da ecoendoscopia e da biopsia guiada por ecoendoscopia no algoritmo de estadiamento do cancro do pâncreas. É ainda analisada a evidência atual que favorece o papel crescente da terapêutica neoadjuvante e a importância da seleção individualizada do tratamento, baseada na definição do subtipo de tumor e na caracterização molecular.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Endoscopic ultrasound]]></kwd>
<kwd lng="en"><![CDATA[Fine-needle biopsy]]></kwd>
<kwd lng="en"><![CDATA[Neoadjuvant therapy]]></kwd>
<kwd lng="en"><![CDATA[Pancreatic cancer staging]]></kwd>
<kwd lng="en"><![CDATA[Personalised medicine]]></kwd>
<kwd lng="en"><![CDATA[Precision therapy]]></kwd>
<kwd lng="pt"><![CDATA[Ecoendoscopia]]></kwd>
<kwd lng="pt"><![CDATA[Biopsia por agulha fina]]></kwd>
<kwd lng="pt"><![CDATA[Estadiamento do cancro do pâncreas]]></kwd>
<kwd lng="pt"><![CDATA[Medicina personalizada]]></kwd>
<kwd lng="pt"><![CDATA[Terapêutica neoadjuvante]]></kwd>
<kwd lng="pt"><![CDATA[Terapêutica de precisão]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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