{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T01:36:27Z","timestamp":1770082587773,"version":"3.49.0"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Pancreatic cancer (PC) is expected to be the second leading cause of cancer-related death by 2030. Surgical resection with R0 margins remains the only available treatment capable of improving the overall survival of the patients; thus, appropriate characterization of pancreatic tumors is mandatory for the correct assessment of PC resectability. Despite advances in pancreatic surgery, POPF remains a frequent and dreaded complication that impacts the morbidity and mortality of PC patients, entailing both clinical and economic consequences. Soft pancreatic texture is known as an independent risk factor for POPF occurrence in pancreatic surgery. Intraoperative exploration of the pancreas is most frequently assessed subjectively, through the surgeon\u2019s palpation. Intraoperative elastography is a modern ultrasound technique suitable to replace the surgeon\u2019s intraoperative palpation to better evaluate pancreatic lesions, pancreatic texture, and improve surgical management. Thus, intraoperative elastography could provide quantifiable and reproducible information in pancreatic parenchyma characterization. Real-time intraoperative assessment of pancreatic texture through an objective method could improve surgical decisions. This systematic review analyzes the role of intraoperative elastography in differentiating benign from malignant pancreatic tumors and the efficacy of this technique in the assessment of pancreatic texture as a predictor of postoperative pancreatic fistula (POPF). Methods: We conducted a comprehensive systematic literature research on PubMed, Google Scholar, Scopus, Web of Science, Embase and Cochrane Library Database using PRISMA framework guided by the words \u201cintraoperative elastography\u201d or \u201cintraoperative elasticity imaging\u201d or \u201cintraoperative shear wave elastography\u201d or \u201cintraoperative strain elastography\u201d and \u201cpancreatic cancer\u201d or \u201cpancreatic neoplasm\u201d or \u201cpancreatic adenocarcinoma\u201d or \u201cpancreatic tumor\u201d or \u201cpancreatic fistula\u201d or \u201cpostoperative pancreatic fistula\u201d or \u201cpancreatic leak\u201d. Articles that were listed between 2000 and 2025 and written in the English language were screened for potentially relevant articles. The primary outcome was to evaluate the use of intraoperative elastography in differentiating between benign and malignant lesions of the pancreas. The second outcome was to assess the role of intraoperative elastography in the evaluation of pancreatic texture as a predictive factor for the occurrence of postoperative pancreatic fistula. Results: From a total of 17 publications, 2 scientific articles were considered relevant for the role of intraoperative elastography in differentiating benign from malignant pancreatic lesions, while 4 articles analyzed the role of intraoperative pancreatic elastography as a predictor of postoperative pancreatic fistula (POPF). Based on the results, detection of pancreatic cancer through intraoperative SWE is possible at cut-off values of 3 m\/s and 28.7 kPa, and values of 2.2 m\/s or less obtained after intraoperative elastography of the pancreas are considered an independent risk factor for POPF in pancreatic surgery. Reported cut-off values should, however, be interpreted as exploratory and should represent a starting point for further studies aimed at validating their clinical implementation. Conclusions: Intraoperative elastography can be a promising tool in pancreatic tumor characterization and could differentiate between benign and malignant pancreatic tumors and predict the risk of POPF, but further prospective studies are required before cut-off values can be routinely applied in clinical practice.<\/jats:p>","DOI":"10.3390\/cancers18030473","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T14:12:46Z","timestamp":1770041566000},"page":"473","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Elastography in Pancreatic Cancer\u2014Clinical Applications and Systematic Review of the Literature"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9056-1033","authenticated-orcid":false,"given":"Miana Gabriela","family":"Pop","sequence":"first","affiliation":[{"name":"Department of Public Health and Management, Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babe\u0219 Str., No. 8, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Pojoga","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., No. 19-21, 400162 Cluj-Napoca, Romania"},{"name":"Department of Clinical Psychology and Psychotherapy, Babe\u0219-Bolyai University, Sindicatelor Str., No. 7, 400029 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana","family":"Barto\u0219","sequence":"additional","affiliation":[{"name":"Regina Maria Health Network, Doroban\u021bilor Str., No. 29, 400609 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florina","family":"Gabor-Harosa","sequence":"additional","affiliation":[{"name":"Department of Public Health and Management, Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babe\u0219 Str., No. 8, 400012 Cluj-Napoca, Romania"},{"name":"Regional Institute of Urology and Renal Transplant Cluj-Napoca, Clinicilor Str., No. 4-6, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandu","family":"Br\u00eenzil\u0103","sequence":"additional","affiliation":[{"name":"Regina Maria Health Network, Doroban\u021bilor Str., No. 29, 400609 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caius Mihai","family":"Breazu","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Cluj County Emergency Clinical Hospital, Clinicilor Str., No. 4-6, 400349 Cluj-Napoca, Romania"},{"name":"1st Department of Anesthesia and Intensive Care, Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babe\u0219 Str., No. 8, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Barto\u0219","sequence":"additional","affiliation":[{"name":"Regina Maria Health Network, Doroban\u021bilor Str., No. 29, 400609 Cluj-Napoca, Romania"},{"name":"Institute for Advanced Studies in Science and Technology\u2014STAR-UBB Institute, Babe\u0219-Bolyai University Cluj-Napoca, Mihail Kogalniceanu Str., No. 1, 400084 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.21873\/anticanres.14856","article-title":"Intraoperative Shear Wave Elastography as a Quantitative Predictor of Pancreatic Fibrosis and Exocrine Function","volume":"41","author":"Wada","year":"2021","journal-title":"Anticancer Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s10396-014-0571-7","article-title":"JSUM ultrasound elastography practice guidelines: Pancreas","volume":"42","author":"Hirooka","year":"2015","journal-title":"J. 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