{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:05:59Z","timestamp":1779181559148,"version":"3.51.4"},"reference-count":84,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Pancreatic cystic lesions (PCLs) represent a growing clinical challenge due to their diverse biological behaviors and the substantial overlap in imaging features between benign, premalignant, and malignant entities. Traditional diagnostic approaches relying on cross-sectional imaging or isolated morphologic criteria frequently fail to achieve adequate risk discrimination. Advances in endoscopic ultrasound (EUS) now permit detailed morphologic assessment complemented by cyst-fluid biochemical markers, proteomic signatures, and comprehensive genomic profiling using next-generation sequencing. Parallel progress in artificial intelligence (AI) further strengthens diagnostic precision by integrating EUS features with multimodal biomarker data to reduce subjectivity and support individualized clinical decision-making. This review introduces an EUS-based multimodal diagnostic framework of PCLs that integrates morphological evaluation, cyst-fluid biochemical testing, molecular profiling, and AI-assisted analysis. By synthesizing current evidence, we outline how the integrative approach enhances diagnostic accuracy, biological interpretability, and individualized risk stratification for PCLs.<\/jats:p>","DOI":"10.3390\/jcm15103893","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T07:35:43Z","timestamp":1779176143000},"page":"3893","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["EUS-Anchored Multimodal Evaluation of Pancreatic Cystic Lesions: Toward a Conceptual Diagnostic Framework"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8760-0006","authenticated-orcid":false,"given":"Enshuo","family":"Liu","sequence":"first","affiliation":[{"name":"Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Yang","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.yacr.2024.04.001","article-title":"A Review of Pancreatic Cystic Lesions on Imaging","volume":"6","author":"Galgano","year":"2024","journal-title":"Adv. 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