Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3579
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.
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.