Needle biopsy for suspicious lesions of the head of the pancreas: pitfalls and implications for therapy

J Gastrointest Surg. Jul-Aug 1997;1(4):337-41. doi: 10.1016/s1091-255x(97)80054-6.

Abstract

Controversy continues to exist concerning the optimal diagnostic approach to a pancreatic head lesion suspected of being a neoplasm. The objective of this study was to evaluate the impact of needle biopsy in suspicious pancreatic head neoplasia and its effect on therapy and outcome. Seventy-three patients with symptoms or signs of periampullary neoplasia and a pancreatic head lesion identified on CT scan were reviewed retrospectively. Forty patients with potentially resectable lesions underwent intraoperative transduodenal core needle biopsy of the head of the pancreas. Thirty-three patients underwent CT-guided percutaneous fine-needle aspiration. The sensitivity and specificity of core needle biopsy were 76% and 100%, respectively. One death was directly related to the procedure and therapy was adversely affected in one patient with a false negative result. The sensitivity and specificity of percutaneous fine-needle aspiration were 85% and 92%, respectively, and were not significantly different from the core needle biopsy results (P >0.3). Three false negative fine-needle aspiration biopsies occurred in patients with potentially resectable lesions and a low clinical suspicion for malignancy. In patients with a mass in the head of the pancreas on CT scan, fine-needle aspiration biopsy offers results similar to those of intraoperative transduodenal core needle biopsy. In patients estimated to have resectable disease, a pancreaticoduodenectomy should be performed without a biopsy. For patients with unresectable disease, cytologic examination of fine-needle aspirate should be performed. If this examination is positive, it offers the advantage of facilitating the construction of a rational plan for palliation.

MeSH terms

  • Biopsy, Fine-Needle
  • Biopsy, Needle* / adverse effects
  • Carcinoma / diagnosis*
  • Carcinoma / diagnostic imaging
  • Carcinoma / pathology
  • Carcinoma / surgery
  • Cytodiagnosis
  • Humans
  • Male
  • Middle Aged
  • Pancreas / pathology*
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery
  • Radiography, Interventional
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed