title: A percutaneous biopsy technique for patients with suspected biliary or pancreatic cancer without a radiographic mass.
abstract: BACKGROUND
  Treatment of malignant pancreatic and/or biliary strictures requires tissue diagnosis. Since cytologic brushings at endoscopic retrograde cholangiopancreatography (ERCP) of these strictures has a poor sensitivity for malignancy (30-83%) (see ME Ryan. Gastrointestinal Endoscopy 1991;37(2):139-143; and MB Cohen, Wittchow RJ, Johlin FC, et al. Mod Pathol 1995;8:498-502), tissue diagnosis must be obtained by another route. We report our experience of percutaneous biopsy of malignant pancreatic and/or biliary strictures even when no radiographic mass is present.
  
  
  METHODS
  At ERCP, five patients demonstrated pancreatic and/or biliary duct strictures, had atypical cytological brushings, and had their strictures stented. No mass to account for the strictures could be identified on CT. These five patients underwent percutaneous biopsy of the persistent material by CT within 10 days of the ERCP.
  
  
  RESULTS
  Two patients had adenocarcinoma of the pancreas. One patient had malignant lymphoma and another had cholangiocarcinoma. One patient had inflammatory cells and was followed.
  
  
  CONCLUSIONS
  If the diagnosis of malignancy cannot be made at the time of the ERCP sampling, then our experience suggests that a percutaneous biopsy should be performed even if a mass is not present using the stent as a target.
authors.affiliation: Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Pelsang
authors.forename: F C
authors.initials: FC
authors.lastname: Johlin
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D001707:Biopsy, Needle / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed