EUS-FNA for Pancreatic Masses in an Emerging African Healthcare System: Diagnostic Yield, Predictive Factors, and Safety Outcomes

Background Pancreatic adenocarcinoma accounts for 80 to 90% of solid pancreatic masses and remains one of the most lethal malignancies worldwide, owing to its aggressive progression, diagnostic delays, and limited therapeutic options once advanced. The global 5-year survival rate remains under 10%, underlining the need for early and effective diagnostic tools. The need for early, accurate, and cost-effective diagnosis is particularly crucial in emerging countries with restricted access to advanced technologies. Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) has emerged as a cornerstone in the diagnosis of pancreatic masses, allowing for histological confirmation and guiding clinical decisions. Despite the increasing use of Fine Needle Biopsy (FNB) in developed centers, FNA remains the mainstay in low-resource environments due to its affordability and wide availability. While FNB provides core tissue for histological analysis, FNA allows for cytological assessment. Aims This study aims to evaluate the diagnostic accuracy of EUS-FNA in detecting malignant pancreatic masses in a tertiary care center in North Africa. Additionally, we aimed to identify predictive factors influencing cytological yield and complication rates, and to highlight the feasibility and limitations of this technique in real-world African practice, contextualized through an extensive literature review. Methods We conducted a retrospective analysis of 183 patients with suspected pancreatic masses who underwent EUS-FNA between January 2018 and August 2024. This is a single-center, real-world study. Data on demographic, clinical, radiological, biological, procedural, and histological parameters were extracted. Multivariate logistic regression was used to determine predictive factors of conclusive cytology and complications. Results The mean age was 63 years, with a male predominance (M/F ratio: 1.3). Pancreatic head was the most common tumor location (60%), and mean lesion size was 4 cm. A conclusive cytological diagnosis was achieved in 80% of cases. no independent predictive factors for diagnostic success were identified in multivariate analysis. Complications were rare (< 1%), with a single true complication observed. Minor adverse events, such as self-limited bleeding, occurred in 4.9% of cases and were not considered clinically significant. Conclusion In this real-world cohort of patients undergoing EUS-FNA for solid pancreatic masses in a resource-limited African setting, the technique demonstrated a high diagnostic yield (80%) and an exceptionally low rate of serious complications (0.5%), confirming its safety and feasibility when performed by experienced operators. While no independent predictive factors for diagnostic success were identified in multivariate analysis, older age, larger tumor size (> 3 cm), and elevated CA 19 − 9 levels emerged as significant independent predictors of minor self-limited bleeding events. These findings underscore the continued relevance of EUS-FNA as a first-line diagnostic tool in emerging healthcare systems, where advanced technologies such as EUS-FNB and ROSE remain limited. Future multicenter prospective studies across Africa are needed to validate these results, assess long-term outcomes, and inform the development of pragmatic, resource-adapted guidelines tailored to the continent’s unique needs.