It is reasonable to obtain a histological diagnosis before treating patients who have pancreatic masses and are unsuitable or unwilling to undergo surgery. As the pancreas is a deep seated organ surrounded by other vital structures, it is a challenge for the physician to obtain an adequate specimen for histological examination. Endoscopic ultrasound-guided biopsy of pancreatic masses has been proved to be a safe and effective method.
However, if the hospital has no such facilities or patients are unwilling or intolerant of the procedure, computed tomography (CT)-guided biopsy is an alternative method.
A research article to be published on December 21, 2009 in the World Journal of Gastroenterology addresses this question. A research team from Taiwan reviewed 34 CT-guided biopsies in patients with pancreas mass, of whom 24 (71%) had a direct path to the mass without passing through a major organ.
Their results showed tumor tissues were obtained in nine pancreatic biopsies, and histologic specimens for diagnosis were obtained in all cases. An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis. No delayed procedure-related complication was seen during the survival period of all patients.
They drew a conclusion that it is feasible to perform transgastric biopsy of a pancreatic lesion using a large needle.
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More information: Tseng HS, Chen CY, Chan WP, Chiang JH. Percutaneous transgastric computed tomography-guided biopsy of the pancreas using large needles.World J Gastroenterol 2009; 15(47): 5972-5975 www.wjgnet.com/1007-9327/15/5972.asp