Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3579-3586
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3579
Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis
Chiang J Tyng, Maria Fernanda A Almeida, Paula NV Barbosa, Almir GV Bitencourt, José Augusto AG Berg, Macello S Maciel, Felipe JF Coimbra, Luiz Henrique O Schiavon, Maria Dirlei Begnami, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak
Chiang J Tyng, Maria Fernanda A Almeida, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil
Felipe JF Coimbra, Maria Dirlei Begnami, Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil
Author contributions: Tyng CJ, Barbosa PNV, Coimbra FJF and Chojniak R designed the research; Tyng CJ, Barbosa PNV, Almeida MFA, Bitencourt AGV, Schiavon LHO, Berg JAAG and Maciel MS performed the research; Almeida MFA, Bitencourt AGV, Berg JAAG, Maciel MS, Begnami MD, Guimarães MD and Zurstrassen CE analyzed the data; all authors wrote and revised the paper.
Ethics approval: The study was reviewed and approved by the Antonio Prudente Foundation and the AC Camargo Cancer Center Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest: The authors have no conflict of interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Almir GV Bitencourt, MD, PhD, Department of Imaging, AC Camargo Cancer Center, R Prof Antonio Prudente 211, São Paulo, SP 09015-010, Brazil.
Telephone: +55-11-21895000-1050 Fax: +55-11-21895000-1050
Received: August 27, 2014
Peer-review started: August 28, 2014
First decision: September 27, 2014
Revised: December 23, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: March 28, 2015

AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions.

METHODS: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form.

RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant.

CONCLUSION: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.

Keywords: Computed tomography, Image-guided biopsy, Large-core needle biopsy, Needle biopsy, Pancreatic neoplasms

Core tip: Histopathologic analysis is often necessary to confirm the diagnosis of pancreatic tumors and aid in treatment planning. Various techniques, such as imaging-guided percutaneous, endoscopic, and surgical biopsies, can be used to obtain material for the cytologic or histologic analysis. In the present study, computed tomography-guided percutaneous core needle biopsies of pancreatic lesions were associated with few complications and 98.1% diagnostic accuracy. The safety and high diagnostic success rate renders this method an excellent minimally invasive option for diagnostic confirmation of solid pancreatic lesions.