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Transabdominal ultrasound-guided pancreatic biopsy: a neglected but safe, effective and inexpensive procedure that needs to be re-juvinalized

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Abstract

Background

For solid pancreatic masses, ultrasound endoscopic fine-needle biopsy is suggested as the front-line investigation for tissue achievement, notwithstanding the optimal performance of transabdominal ultrasound (TUS)-guided biopsy.

Purpose

To reassess the efficacy and effectiveness of TUS-guided sampling and to determine the factors predictive of accurate histology.

Methods

In total, 142 patients with an indication for a TUS-guided biopsy of a pancreatic mass were analyzed. A single pass of an 18-gauge Biomol needle was carried out by the Menghini technique. The accuracy, sensitivity, and specificity of the procedure in terms of correctly diagnosing an inflammatory or neoplastic lesion were determined. The patients’ characteristics, the size and location of the mass, and the sonographers’ experience in performing TUS were recorded.

Results

The sampling was unsuccessful in 24 cases, owing to the deep localization of lesions (57%), bloating (33%), or low patient compliance (10%). The accuracy, sensitivity, and specificity of the 118 successful biopsies were 81%, 79%, and 100%, respectively. A biopsy core was obtained in 90 of the 118 patients (76%) in whom the procedure was attempted. In the multivariate analysis, lesion size (≤ 20 mm vs. > 20 mm) (OR = 5.3 [1.7–17.0]) and operator experience (OR = 4.4 [1.6–12.1]) predicted the acquisition of adequate samples. With an expert sonographer, the accuracy, sensitivity, and specificity were 87%, 85%, and 100%, respectively. Two adverse events were registered: mild abdominal pain and a hypotensive crisis.

Conclusions

The present investigation highlights the optimal performance of a TUS-guided biopsy of a pancreatic mass. Because of its simplicity and safety, the procedure needs to be included among the recommended investigative options

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Division of Gastroenterology and Endoscopy, IRCCS, Fondazione Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71024, San Giovanni Rotondo, Italy

    Fulvia Terracciano, Antonella Marra, Antonio Massimo Ippolito, Fabrizio Bossa, Maria Rosa Valvano & Angelo Andriulli

  2. Hepatology and Biomolecular Clinics, “G. Martino” Hospital, Messina, Italy

    Krizia Sitajolo

  3. Endoscopy Unit, “San Carlo” Hospital, Potenza, Italy

    Annabianca Amoruso

  4. Department of Human Pathology, IRCCS, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy

    Paola Parente & Paolo Graziano

Authors
  1. Fulvia Terracciano
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  2. Antonella Marra
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  3. Antonio Massimo Ippolito
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  4. Fabrizio Bossa
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  5. Krizia Sitajolo
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  6. Annabianca Amoruso
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  7. Paola Parente
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  8. Maria Rosa Valvano
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  9. Paolo Graziano
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  10. Angelo Andriulli
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Contributions

FT, IA, B: performed ultrasound; SK, AA, MA: collected datas; PP, GP: histological analysis; MRV: statistical analysis; AA: writer.

Corresponding author

Correspondence to Fulvia Terracciano.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical statement and informed consent

All subjects gave written informed consent to the treatment of personal data in anonymous form and in accordance with the Declaration of Helsinki.

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Terracciano, F., Marra, A., Ippolito, A.M. et al. Transabdominal ultrasound-guided pancreatic biopsy: a neglected but safe, effective and inexpensive procedure that needs to be re-juvinalized. J Ultrasound 24, 175–182 (2021). https://doi.org/10.1007/s40477-020-00542-y

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  • DOI: https://doi.org/10.1007/s40477-020-00542-y

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