Alternative to Endoscopic Pancreas Biopsy

"We were able to obtain adequate samples in 22 of the 23 cases,” said Kedar Chintapalli, M.D., professor of radiology at the University of Texas Health Science Center (San Antonio, TX, USA), and lead author of the study. The ultrasound-guided biopsies can be done with a biopsy gun or small needles inserted through the skin using local anesthesia. In 16 of the procedures, a 20-guage fine-needle aspiration (FNA) needle was used; seven procedures were performed with an 18-guage biopsy gun.

"Unlike with CT, one can compress the intervening tissues under ultrasound, so that the skin to target distance is less. The entire procedure is performed under real-time ultrasound,” said Dr. Chintapalli. A pathology resident was available when the FNA cases were performed to verify that the sample was adequate. "Adequate samples were obtained by FNA needle and the larger biopsy gun. If we can get an adequate sample we should use a smaller needle,” he said.

In most procedures (61%), a diagnosis was possible after two passes with the biopsy needle. There were no major complications. In 14 of the patients, a malignancy was identified; eight patients had benign results. This procedure is much easier on the patient than using an endoscope, Dr. Chintapalli said. When an endoscope is utilized, it is passed down the throat of the patient, through the patient's stomach and duodenum, and then the pancreatic biopsy is performed. The patient is sedated for the procedure.

The number of percutaneous ultrasound-guided biopsies has decreased because gastroenterologists are doing endoscopic ultrasound biopsies, according to Dr. Chintapalli. He pointed out that this study indicates that it is just as effective and more efficient to do ultrasound-guided percutaneous pancreatic biopsies instead.

The study's results were presented May 19, 2005, at the American Roentgen Ray Society Annual Meeting in New Orleans, LA, USA.




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