Percutaneous Biopsy of the Pancreas

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.