Skip to main content

Percutaneous Biopsy of the Pancreas

  • Chapter
  • First Online:
Percutaneous Image-Guided Biopsy
  • 1669 Accesses

Abstract

Image-guided percutaneous needle biopsy has been shown to be a safe and accurate technique for obtaining samples for pathologic diagnosis in patients presenting with undiagnosed pancreatic masses. Percutaneous needle biopsy is also used for determining the cause of graft dysfunction after pancreatic transplantation. Percutaneous biopsy of the pancreas is generally performed with ultrasound or computed tomography guidance. Pancreatic lesions can be accessed via anterior, posterior, or lateral needle biopsy approaches. An anterior approach is generally preferred, but the presence of intervening structures (such as the small and large bowel and mesenteric blood vessels) often precludes this approach. If a safe anterior approach is not available, a posterior approach can be used for needle biopsy of pancreatic lesions. A posterior approach with the needle traversing the inferior vena cava has been safely used for lesions involving the head and uncinate process of the pancreas. Although fine-needle aspiration biopsy is the most common technique for performing biopsies of pancreatic masses, biopsies using small-caliber (18- to 20-gauge) core needles also have shown to be safe, and studies suggest that core-biopsy samples can increase the overall accuracy of percutaneous biopsy. The diagnostic accuracy of image-guided percutaneous pancreatic biopsy ranges from 45 to 100 %. The reported complication rate for pancreatic biopsies ranges between 0.5 and 3 %, with acute pancreatitis being the most frequent complication.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hancke S, Holm HH, Koch F. Ultrasonically guided percutaneous fine needle biopsy of the pancreas. Surg Gynecol Obstet. 1975;140:361–4.

    CAS  PubMed  Google Scholar 

  2. Brandt KR, Charboneau JW, Stephens DH, Welch TJ, Goellner JR. CT- and US-guided biopsy of the pancreas. Radiology. 1993;187:99–104.

    CAS  PubMed  Google Scholar 

  3. 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;93:1329–33.

    Article  PubMed  Google Scholar 

  4. Dodd LG, Mooney EE, Layfield LJ, Nelson RC. Fine-needle aspiration of the liver and pancreas: a cytology primer for radiologists. Radiology. 1997;203:1–9.

    CAS  PubMed  Google Scholar 

  5. Elvin A, Andersson T, Scheibenpflug L, Lindgren PG. Biopsy of the pancreas with a biopsy gun. Radiology. 1990;176:677–9.

    CAS  PubMed  Google Scholar 

  6. Goldstein HM, Zornoza J. Percutaneous transperitoneal aspiration biopsy of pancreatic masses. Am J Dig Dis. 1978;23:840–3.

    Article  CAS  PubMed  Google Scholar 

  7. 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;222:63–9.

    Article  PubMed  Google Scholar 

  8. Hajdu EO, Kumari-Subaiya S, Phillips G. Ultrasonically guided percutaneous aspiration biopsy of the pancreas. Semin Diagn Pathol. 1986;3:166–75.

    CAS  PubMed  Google Scholar 

  9. Edoute Y, Lemberg S, Malberger E. Preoperative and intraoperative fine needle aspiration cytology of pancreatic lesions. Am J Gastroenterol. 1991;86:1015–19.

    CAS  PubMed  Google Scholar 

  10. Di Stasi M, Cavanna L, Fornari F, et al. Obstructive jaundice secondary to non-Hodgkin's lymphoma: usefulness of ultrasound-guided fine-needle aspiration biopsy (UG-FNAB). Eur J Haematol. 1990;44:265–6.

    Article  PubMed  Google Scholar 

  11. Webb TH, Lillemoe KD, Pitt HA, Jones RJ, Cameron JL. Pancreatic lymphoma. Is surgery mandatory for diagnosis or treatment? Ann Surg. 1989;209:25–30.

    Article  CAS  PubMed  Google Scholar 

  12. Carlson SK, Johnson CD, Brandt KR, Batts KP, Salomao DR. Pancreatic cystic neoplasms: the role and sensitivity of needle aspiration and biopsy. Abdom Imaging. 1998;23:387–93.

    Article  CAS  PubMed  Google Scholar 

  13. Delatour NR, Policarpio-Nicolas ML, Yazdi H, Islam S. Fine needle aspiration biopsy for preoperative workup of pancreatic cystic neoplasms: report of 4 cases. Acta Cytol. 2007;51:925–33.

    Article  PubMed  Google Scholar 

  14. Attasaranya S, Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP. 2007;8:553–63.

    PubMed  Google Scholar 

  15. Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc. 2009;69:1095–102.

    Article  PubMed  Google Scholar 

  16. Lewandrowski K, Lee J, Southern J, Centeno B, Warshaw A. Cyst fluid analysis in the differential diagnosis of pancreatic cysts: a new approach to the preoperative assessment of pancreatic cystic lesions. Am J Roentgenol. 1995;164:815–19.

    Article  CAS  Google Scholar 

  17. Lewandrowski KB, Southern JF, Pins MR, Compton CC, Warshaw AL. Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Ann Surg. 1993;217:41–7.

    Article  CAS  PubMed  Google Scholar 

  18. Ryu JK, Woo SM, Hwang JH, et al. Cyst fluid analysis for the differential diagnosis of pancreatic cysts. Diagn Cytopathol. 2004;31:100–5.

    Article  PubMed  Google Scholar 

  19. Sperti C, Pasquali C, Guolo P, et al. Evaluation of cyst fluid analysis in the diagnosis of pancreatic cysts. Ital J Gastroenterol. 1995;27:479–83.

    CAS  PubMed  Google Scholar 

  20. D'Onofrio M, Malago R, Zamboni G, Manfrin E, Pozzi Mucelli R. Ultrasonography of the pancreas. 5. Interventional procedures. Abdom Imaging. 2007;32:182–90.

    Article  PubMed  Google Scholar 

  21. Robins DB, Katz RL, Evans DB, Atkinson EN, Green L. Fine needle aspiration of the pancreas. In quest of accuracy. Acta Cytol. 1995;39:1–10.

    CAS  PubMed  Google Scholar 

  22. Carlson SK, Bender CE, Classic KL, et al. Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology. 2001;219:515–20.

    CAS  PubMed  Google Scholar 

  23. Zech CJ, Helmberger T, Wichmann MW, Holzknecht N, Diebold J, Reiser MF. Large core biopsy of the pancreas under CT fluoroscopy control: results and complications. J Comput Assist Tomogr. 2002;26:743–9.

    Article  PubMed  Google Scholar 

  24. Pelsang RE, Johlin FC. A percutaneous biopsy technique for patients with suspected biliary or pancreatic cancer without a radiographic mass. Abdom Imaging. 1997;22:307–10.

    Article  CAS  PubMed  Google Scholar 

  25. Amin Z, Kessel D, Lees WR. Percutaneous biopsy of pancreatic masses in patients with biliary metal stents: the snags! Clin Radiol. 1995;50:276.

    Article  CAS  PubMed  Google Scholar 

  26. 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. Am J Roentgenol. 2002;179:109–12.

    Article  Google Scholar 

  27. Gagnon P, Boustiere C, Ponchon T, Valette PJ, Genin G, Labadie M. Percutaneous fine-needle aspiration cytologic study of main pancreatic duct stenosis under pancreatographic guidance. Cancer. 1991;67:2395–400.

    Article  CAS  PubMed  Google Scholar 

  28. 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;19:89–94.

    Article  CAS  PubMed  Google Scholar 

  29. 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;6:222–4.

    Article  CAS  PubMed  Google Scholar 

  30. Ferrucci Jr JT, Wittenberg J, Mueller PR, et al. Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy. Am J Roentgenol. 1980;134:323–30.

    Article  Google Scholar 

  31. Gupta S, Madoff DC. Image-guided percutaneous needle biopsy in cancer diagnosis and staging. Tech Vasc Interv Radiol. 2007;10: 88–101.

    Article  PubMed  Google Scholar 

  32. Gupta S, Nguyen HL, Morello Jr FA, et al. Various approaches for CT-guided percutaneous biopsy of deep pelvic lesions: anatomic and technical considerations. Radiographics. 2004;24:175–89.

    Article  PubMed  Google Scholar 

  33. Haaga JR, Beale SM. Use of CO2 to move structures as an aid to percutaneous procedures. Radiology. 1986;161:829–30.

    CAS  PubMed  Google Scholar 

  34. Langen HJ, Jochims M, Gunther RW. Artificial displacement of kidneys, spleen, and colon by injection of physiologic saline and CO2 as an aid to percutaneous procedures: experimental results. J Vasc Interv Radiol. 1995;6:411–16.

    Article  CAS  PubMed  Google Scholar 

  35. van Sonnenberg E, Wittenberg J, Ferrucci Jr JT, Mueller PR, Simeone JF. Triangulation method for percutaneous needle guidance: the angled approach to upper abdominal masses. Am J Roentgenol. 1981;137:757–61.

    Article  Google Scholar 

  36. Gupta S. New techniques in image-guided percutaneous biopsy. Cardiovasc Intervent Radiol. 2004;27:91–104.

    Article  PubMed  Google Scholar 

  37. Wallace MJ, Gupta S, Hicks ME. Out-of-plane computed-tomography-guided biopsy using a magnetic-field-based navigation system. Cardiovasc Intervent Radiol. 2006;29:108–13.

    Article  PubMed  Google Scholar 

  38. Sofocleous CT, Schubert J, Brown KT, Brody LA, Covey AM, Getrajdman GI. CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions. J Vasc Interv Radiol. 2004;15:1099–104.

    Article  PubMed  Google Scholar 

  39. Gupta S, Seaberg K, Wallace MJ, et al. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics. 2005;25:763–86; discussion 786–8.

    Article  PubMed  Google Scholar 

  40. Megibow AJ, Bosniak MA, Ambos MA, Beranbaum ER. Thickening of the celiac axis and/or superior mesenteric artery: a sign of pancreatic carcinoma on computed tomography. Radiology. 1981;141:449–53.

    CAS  PubMed  Google Scholar 

  41. O'Connell MJ, Paulson EK, Jaffe TA, Ho LM. Percutaneous biopsy of periarterial soft tissue cuffs in the diagnosis of pancreatic carcinoma. Abdom Imaging. 2004;29:115–19.

    Article  PubMed  Google Scholar 

  42. 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;26:126–31.

    CAS  PubMed  Google Scholar 

  43. Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors. Am J Roentgenol. 1986;147:399–403.

    Article  CAS  Google Scholar 

  44. Mitchell CJ, Wai D, Jackson AM, MacFie J. Ultrasound guided percutaneous pancreatic biopsy. Br J Surg. 1989;76:706–7.

    Article  CAS  PubMed  Google Scholar 

  45. Wittenberg J, Mueller PR, Ferrucci Jr JT, et al. Percutaneous core biopsy of abdominal tumors using 22 gauge needles: further observations. Am J Roentgenol. 1982;139:75–80.

    Article  CAS  Google Scholar 

  46. Pinto MM. CT-guided needle biopsy of the pancreas. Am J Gastroenterol. 1993;88:967–8.

    CAS  PubMed  Google Scholar 

  47. Jennings PE, Donald JJ, Coral A, Rode J, Lees WR. Ultrasound-guided core biopsy. Lancet. 1989;1:1369–71.

    Article  CAS  PubMed  Google Scholar 

  48. Munn SR, Engen DE, Barr D, Carpenter HA, Perkins JD. Differential diagnosis of hypoamylasuria in pancreas allograft recipients with urinary exocrine drainage. Transplantation. 1990;49:359–62.

    Article  CAS  PubMed  Google Scholar 

  49. Sibley RK, Sutherland DE. Pancreas transplantation. An immunohistologic and histopathologic examination of 100 grafts. Am J Pathol. 1987;128:151–70.

    CAS  PubMed  Google Scholar 

  50. Carpenter HA, Engen DE, Munn SR, et al. Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Am J Surg Pathol. 1990;14:837–46.

    Article  CAS  PubMed  Google Scholar 

  51. Perkins JD, Munn SR, Marsh CL, Barr D, Engen DE, Carpenter HA. Safety and efficacy of cystoscopically directed biopsy in pancreas transplantation. Transplant Proc. 1990;22:665–6.

    CAS  PubMed  Google Scholar 

  52. Aideyan OA, Schmidt AJ, Trenkner SW, Hakim NS, Gruessner RW, Walsh JW. CT-guided percutaneous biopsy of pancreas transplants. Radiology. 1996;201:825–8.

    CAS  PubMed  Google Scholar 

  53. Bernardino M, Fernandez M, Neylan J, Hertzler G, Whelchel J, Olson R. Pancreatic transplants: CT-guided biopsy. Radiology. 1990;177:709–11.

    CAS  PubMed  Google Scholar 

  54. Evans WK, Ho CS, McLoughlin MJ, Tao LC. Fatal necrotizing pancreatitis following fine-needle aspiration biopsy of the pancreas. Radiology. 1981;141:61–2.

    CAS  PubMed  Google Scholar 

  55. Levin DP, Bret PM. Percutaneous fine-needle aspiration biopsy of the pancreas resulting in death. Gastrointest Radiol. 1991;16:67–9.

    Article  CAS  PubMed  Google Scholar 

  56. Mueller PR, Miketic LM, Simeone JF, et al. Severe acute pancreatitis after percutaneous biopsy of the pancreas. Am J Roentgenol. 1988;151:493–4.

    Article  CAS  Google Scholar 

  57. Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 1991;178:253–8.

    CAS  PubMed  Google Scholar 

  58. Kane NM, Korobkin M, Francis IR, Quint LE, Cascade PN. Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach. Am J Roentgenol. 1991;157:777–80.

    Article  CAS  Google Scholar 

  59. Warshaw AL. Implications of peritoneal cytology for staging of early pancreatic cancer. Am J Surg. 1991;161:26–9; discussion 29–30.

    Article  CAS  PubMed  Google Scholar 

  60. Leach SD, Rose JA, Lowy AM, et al. Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head. Surgery. 1995;118:472–8.

    Article  CAS  PubMed  Google Scholar 

  61. Johnson DE, Pendurthi TK, Balshem AM, et al. Implications of fine-needle aspiration in patients with resectable pancreatic cancer. Am Surg. 1997;63:675–9; discussion 679–80.

    CAS  PubMed  Google Scholar 

  62. Smith FP, Macdonald JS, Schein PS, Ornitz RD. Cutaneous seeding of pancreatic cancer by skinny-needle aspiration biopsy. Arch Intern Med. 1980;140:855.

    Article  CAS  PubMed  Google Scholar 

  63. Rashleigh-Belcher HJ, Russell RC, Lees WR. Cutaneous seeding of pancreatic carcinoma by fine-needle aspiration biopsy. Br J Radiol. 1986;59:182–3.

    Article  CAS  PubMed  Google Scholar 

  64. Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc. 2002;56:218–24.

    Article  PubMed  Google Scholar 

  65. Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc. 2000;51:184–90.

    Article  CAS  PubMed  Google Scholar 

  66. Rodriguez J, Kasberg C, Nipper M, Schoolar J, Riggs MW, Dyck WP. CT-guided needle biopsy of the pancreas: a retrospective analysis of diagnostic accuracy. Am J Gastroenterol. 1992;87:1610–13.

    CAS  PubMed  Google Scholar 

  67. Tillou A, Schwartz MR, Jordan Jr PH. Percutaneous needle biopsy of the pancreas: when should it be performed? World J Surg. 1996;20:283–6, discussion 287.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sanjay Gupta MD, DNB .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gupta, S. (2014). Percutaneous Biopsy of the Pancreas. In: Ahrar, K., Gupta, S. (eds) Percutaneous Image-Guided Biopsy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8217-8_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8217-8_14

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8216-1

  • Online ISBN: 978-1-4614-8217-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics