Aims and objectives
The purpose of this exhibit is to review the US-guided percutaneous core biopsy of pancreatic tumor (USPPB) including indications,
approach paths,
tips of needle handling,
contraindications,
and potential complications,
with emphasis on how to decide safe needle pathway using video clips and illustrations.
Methods and materials
General overview of USPPB
A.
indications
The first indication is to confirm suspected malignancy in the pancreas.
According to NCCN guidelines for pancreatic adenocarcinoma,
histopathological confirmation is strongly recommended because all patients with unresectable pancreatic cancer should have confirmation before non-surgical treatment (1).
The second is to determine nature of indeterminate lesion in the pancreas,
and the last is to confirm mass suspected to be benign but in which benignity must be established.
B.
Contraindications
USPPB should be avoided in patients with uncorrectable coagulopathy,
poor...
Results
Technical tips and tricks for safe and effective USPPB
How to select biopsy needle
Selection of adequate biopsy needle is very important for successful USPPB.
It affects successful acquisition of adequate target tissue.
A variety of needles with broad spectrums of calibers,
lengths,
and tip design are commercially available for percutaneous biopsy.
Needle caliber is important factor for successful USPPB.
In general,
small caliber needles (20 to 25 gauge) are used primarily to obtain specimens for cytologic analysis and large caliber needles (14 to 19...
Conclusion
Technically,
US-guided percutaneous core biopsy of pancreatic tumor is still challenging.
However,
it could be a safe and feasible method with a full understanding of the proper methodology.
We review the USPPB with various cases with video clips and illustrations: Proper planning of approach path for USPPB according to the location of pancreatic tumors Technical tips and tricks to ensure safe biopsy and to avoid potential complications
Personal information
Jin Woong Kim,
MD.
PhD.
Associate professor
Department of Diagnostic Radiology
Chonnam National University Hwasun Hospital
#160 Ilsim-ri,
Hwasun-eup,
Hwasun-gun,
Jeollanam-do,
519-809,
South Korea
[email protected]
References
1.
National Comprehensive Cancer Network.
NCCN Clinical Practice Guidelines in Oncology.
Pancreatic Adenocarcinoma.
National Comprehensive Cancer Network: Fort Washington,
2010
2.
Kliewer MA,
Sheafor DH,
Paulson EK,
Helsper RS,
Hertzberg BS,
Nelson RC.
Percutaneous liver biopsy: A cost-benefit analysis comparing sonographic and ct guidance.
AJR Am J Roentgenol 1999;173:1199-1202
3.
Sheafor DH,
Paulson EK,
Kliewer MA,
DeLong DM,
Nelson RC.
Comparison of sonographic and ct guidance techniques: Does ct fluoroscopy decrease procedure time? AJR Am J Roentgenol 2000;174:939-942
4.
Sheafor DH,
Paulson EK,
Simmons CM,...