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Introduction Endoscopic ultrasound (EUS)–guided biopsy is central to the diagnosis of pancreatic and upper gastrointestinal (UGI) pathology. Access to specialist gastrointestinal (GI) histopathology and cytology reporting is not universally available, limiting EUS service provision in some centres. To address this, a sub-regional collaboration was established between County Durham and Darlington Trust (CDDFT) and University Hospital of North Tees (UHNT). EUS fine-needle biopsy (FNB) specimens from CDDFT were referred to UHNT for specialist pathology reporting. The aim of this study was to evaluate the diagnostic yield and performance, safety and to assess the feasibility of this model.Methods All consecutive patients undergoing EUS-guided biopsy, following discussion at the CDDFT UGI multidisciplinary team (MDT), between 1 January 2024 and 31 December 2025 were included. Data collected included final clinical diagnosis, biopsy adequacy, number of needle passes, and procedure-related complications. All specimens were processed and reported by specialist GI pathologists at UHNT. Biopsy results were discussed at the UHNT UGI MDT, with outcomes communicated back to CDDFT for management and follow-up. Final MDT diagnosis with clinical and radiological follow-up was used as the reference standard. For pancreatic cancer, biopsy results were considered positive only when definitive malignancy was reported; suspicious, atypical, benign, or non-diagnostic results were classified as test-negative.Results 91 EUS-guided biopsies were performed (54% male; median age 68 years). Tissue adequacy was achieved in 92% of cases, with seven biopsies classified as non-diagnostic. 70 pancreatic mass lesions were sampled, including 65 primary pancreatic cancers. See table 1.3 procedure-related complications occurred including one major GI bleed requiring embolisation.Conclusion EUS-FNB supported by off-site specialist histopathology reporting demonstrates high diagnostic yield, high sensitivity for pancreatic cancer, and an acceptable safety profile. This collaborative model is feasible, scalable, and may support wider access to high-quality EUS diagnostics in non-tertiary centres lacking on-site specialist pathologist. This network-based approach aligns with the principles outlined Getting It Right First Time (GIRFT) programme for pancreatic cancer, which emphasises regional collaboration, equitable access to specialist expertise, and reduction of unwarranted variation in diagnostic pathways.Abstract P287 Table 1Diagnostic performance of EUS-FNB for pancreatic cancerDiagnostic metricAll biopsies included (N=91)Inadequate samples excluded (N=84)Sensitivity88%93%Specificity100%100%Positive predictive value (PPV)100%100%Negative predictive value (NPV)57%64%Diagnostic accuracy90%94%