Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

Abstract

Endoscopic, ultrasound-guided tissue acquisition (EUS-TA) with rapid on-site evaluation is recommended as a first choice in the diagnosis of pancreatic lesions. Since EUS facilities and rapid on-site evaluation are not widely available, even in medical centers, an alternative for precise diagnoses of pancreatic tumor is warranted. The percutaneous computed tomography-guided, core needle biopsy (CT-CNB) is a commonly applicable method for biopsies. Our institute has developed a fat-transversing approach for pancreatic biopsies which is able to approach most tumors in the pancreas without penetrating organs or vessels. Herein, we report a 15-year experiment of pancreatic tumor coaxial CT-CNB in 420 patients. The success rate of tissue yielding by the technique was 99.3%. The overall sensitivity, specificity, and accuracy were 93.2%, 100%, and 93.4%, respectively. The diagnostic accuracy could be increased to 96.4% in 2016–2018 (after the learning curve period). The overall complication rate was 8.6%. Neither life-threatening major complications, nor seeding through the biopsy tract, were observed. Our study supported the hypothesis that CT-CNB could be a complementary option for diagnostic tissue acquisition in patients with unresectable or metastatic pancreatic tumors when EUS-TA is either unsuitable or unavailable.

Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions

“…Complication rates of EUS-guided biopsies range between 3.6% and 22% 18,19 . In CT-guided percutaneous biopsy procedures, the total rates of minor and major complications range from 8.6% to 20% 20–22 . The likelihood of the occurrence of minor or major bleeding due to vascular injuries is high across general complications of biopsy procedures.…”

“…18,19 In CT-guided percutaneous biopsy procedures, the total rates of minor and major complications range from 8.6% to 20%. [20][21][22] The likelihood of the occurrence of minor or major bleeding due to vascular injuries is high across general complications of biopsy procedures. To avoid bleeding as a complication, color Doppler US can be used to identify the major vessels around the large abdominal organs and to plan the biopsy track away from them.…”

The experience of neoadjuvant chemotherapy versus upfront surgery in resectable pancreatic cancer: a cross sectional study

“…The treatment strategy (NAC or UR) and the regimen used in NAC was determined on the basis of shared decision-making after patients understood the possible adverse effects and outcome in the reported clinical trials 30 . If patients determined to receive NAC, endoscopic ultrasound-guided biopsy or computed tomography-guided biopsy was performed to acquire the definite pathological diagnosis 31 , 32 . Subclavian port-A was then inserted for chemotherapy.…”