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Digestive Disease Interventions 2018; 02(02): 095-100
DOI: 10.1055/s-0038-1660431
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Image-Guided Biopsy of the Pancreas

Stephen McRae
1   Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
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Publication History

29 January 2018

20 April 2018

Publication Date:
15 June 2018 (online)

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Abstract

Percutaneous image-guided biopsy of the pancreas is a safe, effective, efficient, and minimally invasive way to obtain samples for pathological diagnosis of pancreatic mass lesions. The myriad of diseases that can involve the pancreas require different therapies. Therefore, pathological diagnosis is key. With proper imaging resources and techniques, most mass lesions of the pancreas that are visible on cross-sectional imaging can be approached safely and accurately percutaneously under either computed tomography (CT) or ultrasound guidance. These lesions may be accessed through anterior, posterior, and/or lateral approaches depending upon their proximity to the anticipated skin puncture site, and the presence or absence of intervening structures. While the ideal percutaneous route to any pancreatic target lesion is the one that has no vital structures in its path, methods and tools exist to make even the most seemingly obstructed paths to pancreatic targets navigable. Once accessed, the targets may be sampled by either fine-needle aspiration or core needle biopsy. The alternatives to percutaneous image-guided biopsy of the pancreas include open (surgical) biopsy and endoscopic ultrasound-guided (EUS) biopsy. Percutaneous image-guided biopsy poses less risk to the patient than open biopsy and has been shown to be as accurate as EUS biopsy with an even lower complication rate.

Keywords

percutaneous - pancreas
 

  • References

  • 1 Pelsang RE, Johlin FC. A percutaneous biopsy technique for patients with suspected biliary or pancreatic cancer without a radiographic mass. Abdom Imaging 1997; 22 (03) 307-310
    CrossrefPubMedGoogle Scholar
  • 2 Adsay NV, Basturk O, Klimstra DS, Klöppel G. Pancreatic pseudotumors: non-neoplastic solid lesions of the pancreas that clinically mimic pancreas cancer. Semin Diagn Pathol 2004; 21 (04) 260-267
    CrossrefPubMedGoogle Scholar
  • 3 Tam AL, Lim HJ, Wistuba II. , et al. Image-guided biopsy in the era of personalized cancer care: Proceedings from the Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2016; 27 (01) 8-19
    CrossrefPubMedGoogle Scholar
  • 4 Mitchell CJ, Wai D, Jackson AM, MacFie J. Ultrasound guided percutaneous pancreatic biopsy. Br J Surg 1989; 76 (07) 706-707
    CrossrefPubMedGoogle Scholar
  • 5 Gupta S, Ahrar K, Morello Jr FA, Wallace MJ, Hicks ME. Masses in or around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach. Radiology 2002; 222 (01) 63-69
    CrossrefPubMedGoogle Scholar
  • 6 Amin Z, Kessel D, Lees WR. Percutaneous biopsy of pancreatic masses in patients with biliary metal stents: the snags!. Clin Radiol 1995; 50 (04) 276
    PubMedGoogle Scholar
  • 7 Gupta S, Ahrar K, Morello Jr FA, Wallace MJ, Madoff DC, Hicks ME. Using a coaxial technique with a curved inner needle for CT-guided fine-needle aspiration biopsy. AJR Am J Roentgenol 2002; 179 (01) 109-112
    CrossrefPubMedGoogle Scholar
  • 8 Gupta S. New techniques in image-guided percutaneous biopsy. Cardiovasc Intervent Radiol 2004; 27 (02) 91-104
    PubMedGoogle Scholar
  • 9 Wallace MJ, Gupta S, Hicks ME. Out-of-plane computed-tomography-guided biopsy using a magnetic-field-based navigation system. Cardiovasc Intervent Radiol 2006; 29 (01) 108-113
    CrossrefPubMedGoogle Scholar
  • 10 Ferrucci Jr JT, Wittenberg J, Mueller PR. , et al. Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy. AJR Am J Roentgenol 1980; 134 (02) 323-330
    CrossrefPubMedGoogle Scholar
  • 11 Elvin A, Andersson T, Scheibenpflug L, Lindgren PG. Biopsy of the pancreas with a biopsy gun. Radiology 1990; 176 (03) 677-679
    CrossrefPubMedGoogle Scholar
  • 12 Solmi L, Muratori R, Bacchini P, Primerano A, Gandolfi L. Comparison between echo-guided fine-needle aspiration cytology and microhistology in diagnosing pancreatic masses. Surg Endosc 1992; 6 (05) 222-224
    CrossrefPubMedGoogle Scholar
  • 13 Li L, Liu LZ, Wu QL. , et al. CT-guided core needle biopsy in the diagnosis of pancreatic diseases with an automated biopsy gun. J Vasc Interv Radiol 2008; 19 (01) 89-94
    CrossrefPubMedGoogle Scholar
  • 14 Evans WK, Ho CS, McLoughlin MJ, Tao LC. Fatal necrotizing pancreatitis following fine-needle aspiration biopsy of the pancreas. Radiology 1981; 141 (01) 61-62
    CrossrefPubMedGoogle Scholar
  • 15 Levin DP, Bret PM. Percutaneous fine-needle aspiration biopsy of the pancreas resulting in death. Gastrointest Radiol 1991; 16 (01) 67-69
    CrossrefPubMedGoogle Scholar
  • 16 Mueller PR, Miketic LM, Simeone JF. , et al. Severe acute pancreatitis after percutaneous biopsy of the pancreas. AJR Am J Roentgenol 1988; 151 (03) 493-494
    CrossrefPubMedGoogle Scholar
  • 17 Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology 1991; 178 (01) 253-258
    CrossrefPubMedGoogle Scholar
  • 18 Kane NM, Korobkin M, Francis IR, Quint LE, Cascade PN. Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach. AJR Am J Roentgenol 1991; 157 (04) 777-780
    CrossrefPubMedGoogle Scholar
  • 19 Brandt KR, Charboneau JW, Stephens DH, Welch TJ, Goellner Jr JR. CT- and US-guided biopsy of the pancreas. Radiology 1993; 187 (01) 99-104
    CrossrefPubMedGoogle Scholar
  • 20 Robins DB, Katz RL, Evans DB, Atkinson EN, Green L. Fine needle aspiration of the pancreas. In quest of accuracy. Acta Cytol 1995; 39 (01) 1-10
    PubMedGoogle Scholar
  • 21 Smith FP, Macdonald JS, Schein PS, Ornitz RD. Cutaneous seeding of pancreatic cancer by skinny-needle aspiration biopsy. Arch Intern Med 1980; 140 (06) 855
    PubMedGoogle Scholar
  • 22 Rashleigh-Belcher HJ, Russell RC, Lees WR. Cutaneous seeding of pancreatic carcinoma by fine-needle aspiration biopsy. Br J Radiol 1986; 59 (698) 182-183
    CrossrefPubMedGoogle Scholar
  • 23 Di Stasi M, Lencioni R, Solmi L. , et al. Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study. Am J Gastroenterol 1998; 93 (08) 1329-1333
    CrossrefPubMedGoogle Scholar
  • 24 Hajdu EO, Kumari-Subaiya S, Phillips G. Ultrasonically guided percutaneous aspiration biopsy of the pancreas. Semin Diagn Pathol 1986; 3 (03) 166-175
    PubMedGoogle Scholar
  • 25 Sperti C, Pasquali C, Di Prima F. , et al. Percutaneous CT-guided fine needle aspiration cytology in the differential diagnosis of pancreatic lesions. Ital J Gastroenterol 1994; 26 (03) 126-131
    PubMedGoogle Scholar
  • 26 Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors. AJR Am J Roentgenol 1986; 147 (02) 399-403
    CrossrefPubMedGoogle Scholar