title: Management of diagnostic dilemmas of the pancreas by ultrasonographically guided laparoscopic biopsy.
abstract: BACKGROUND
  Pancreatic lesions may be difficult to diagnose because of small size or inaccessibility. Such lesions are being seen with increasing frequency because of advances in pancreatic imaging techniques. In the past 18 months we have evaluated 14 patients whose pancreatic lesions could not be diagnosed by traditional means, including percutaneous biopsy.
  
  
  METHODS
  With the patient under general anesthesia, the anterior surface of the pancreas was exposed by a three-trocar laparoscopic technique. The lesion was located by laparoscopic ultrasonography. A core biopsy needle was inserted into the lesion under simultaneous visual and ultrasonographic guidance using picture-in-picture techniques.
  
  
  RESULTS
  The main diagnostic dilemma encountered was the differentiation of pancreatic cancer from pancreatitis. Other conditions were lymphoma and renal cell carcinoma. Excellent tissue samples were obtained, allowing diagnosis and planning of treatment in all cases. Operative time ranged from 1 to 4 hours, and length of stay ranged from 1 to 3 days. Blood transfusions were not required, and there were no complications. Alcohol nerve block was performed laparoscopically in one patient in this group after the diagnosis was made by frozen section.
  
  
  CONCLUSIONS
  Direct ultrasonographically guided laparoscopic biopsy provides rapid, safe diagnosis of pancreatic lesions.
authors.affiliation: Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: W D
authors.initials: WD
authors.lastname: Middleton
authors.forename: S A
authors.initials: SA
authors.lastname: Teefey
authors.forename: M S
authors.initials: MS
authors.lastname: McNevin
authors.forename: J A
authors.initials: JA
authors.lastname: Drebin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000473:pathology*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography