Abstract
Background
The aims of this study were to investigate the diagnostic value and safety of ultrasound-guided percutaneous pancreatic tumor biopsy (pancreatic biopsy) in patients with suspected unresectable pancreatic cancer, and to compare the data with those obtained by metastatic liver tumor biopsy (liver metastases biopsy).
Methods
Data were collected retrospectively from 388 patients (398 procedures) for whom a final diagnosis was available and who underwent ultrasoundguided pancreatic or liver metastases biopsy with a 21-gauge needle (core biopsy) or a 22-gauge needle (fine-needle aspiration biopsy: FNAB). The sensitivity, specificity, and accuracy of pancreatic and liver metastases biopsies were evaluated. Biopsy-related complications were collected and analyzed.
Results
Data from 271 pancreatic and 112 liver metastases biopsy procedures were available. For pancreatic core biopsy and FNAB, the sensitivity, specificity, and accuracy were 93%, 100%, and 93%, and 86%, 100%, and 86%, respectively, all of which were comparable to those of liver metastases biopsy. The complication rate in pancreatic biopsy was 21.4%, including a 4.4% incidence of post-biopsy ephemeral fever. The complication rate in liver metastases biopsy was 38.7%, including an 8.0% incidence of ephemeral fever. Fever and infection occurred more frequently among patients who underwent liver metastases biopsy (4.4% vs. 11%: P = 0.038). In pancreatic biopsy cases, a prebiopsy high serum total bilirubin level was a statistically significant predictor of ephemeral fever.
Conclusions
Ultrasound-guided percutaneous pancreatic biopsy is an effective and safe modality for confirming the pathologic diagnosis in patients with unresectable pancreatic cancer.
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References
NCCN clinical practice guidelines in oncology. Pancreatic adenocarcinoma, vol. 2. National Comprehensive Cancer Network; 2006.
Bret PM, Nicolet V, Labadie M. Percutaneous fine-needle aspiration biopsy of the pancreas. Diagn Cytopathol 1986;2:221–227.
Hajdu EO, Kumari-Subaiya S, Phillips G. Ultrasonically guided percutaneous aspiration biopsy of the pancreas. Semin Diagn Pathol 1986;3:166–175.
Brandt KR, Charboneau JW, Stephens DH, Welch TJ, Goellner JR. CT-and US-guided biopsy of the pancreas. Radiology 1993;187:99–104.
Tillou A, Schwartz MR, Jordan PH Jr. Percutaneous needle biopsy of the pancreas: when should it be performed? World J Surg 1996;20:283–286;discussion 7.
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;56:218–224.
Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology 1991;178:253–258.
Linder S, Blasjo M, Sundelin P, von Rosen A. Aspects of percutaneous fine-needle aspiration biopsy in the diagnosis of pancreatic carcinoma. Am J Surg 1997;174:303–306.
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;26:743–749.
Di Stasi M, Lencioni R, Solmi L, Magnolfi F, Caturelli E, De Sio I, et al. Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study. Am J Gastroenterol 1998;93:1329–1333.
Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 2003;98:2663–2668.
Gines A, Wiersema MJ, Clain JE, Pochron NL, Rajan E, Levy MJ. Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue. Gastrointest Endosc 2005;62:597–601.
Ryozawa S, Kitoh H, Gondo T, Urayama N, Yamashita H, Ozawa H, et al. Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer. J Gastroenterol 2005;40:907–911.
Balen FG, Little A, Smith AC, Theis BA, Abrams KR, Houghton J, et al. Biopsy of inoperable pancreatic tumors does not adversely influence patient survival time. Radiology 1994;193:753–755.
Warshaw AL. Implications of peritoneal cytology for staging of early pancreatic cancer. Am J Surg 1991;161:26–29; discussion 9–30.
Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc 2003;58:690–695.
DelMaschio A, Vanzulli A, Sironi S, Castrucci M, Mellone R, Staudacher C, et al. Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assessment, US, CT, and CT-guided fine-needle biopsy. Radiology 1991;178:95–99.
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;87:1610–1613.
Binmoeller KF, Thul R, Rathod V, Henke P, Brand B, Jabusch HC, et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc 1998;47:121–127.
Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J, et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut 1999;44:720–726.
Voss M, Hammel P, Molas G, Palazzo L, Dancour A, O’Toole D, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut 2000;46:244–249.
Itoi T, Itokawa F, Sofuni A, Nakamura K, Tsuchida A, Yamao K, et al. Puncture of solid pancreatic tumors guided by endoscopic ultrasonography: a pilot study series comparing Trucut and 19-gauge and 22-gauge aspiration needles. Endoscopy 2005;37:362–366.
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Matsubara, J., Okusaka, T., Morizane, C. et al. Ultrasound-guided percutaneous pancreatic tumor biopsy in pancreatic cancer: a comparison with metastatic liver tumor biopsy, including sensitivity, specificity, and complications. J Gastroenterol 43, 225–232 (2008). https://doi.org/10.1007/s00535-007-2142-9
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DOI: https://doi.org/10.1007/s00535-007-2142-9