title: The role of preoperative biopsy in pancreatic cancer.
abstract: BACKGROUND
  Cyto-histological diagnosis of pancreatic pathology in the management of suspected pancreatic malignancy is re-evaluated in the light of evolving trends in management and tissue sampling.
  
  
  METHODS
  The literature on cyto-histological diagnosis of pancreatic pathology was reviewed over the period 1977-2003.
  
  
  CONCLUSIONS
  Endoluminal techniques of tissue sampling carry less risk of tumour seeding and are the sampling methods of choice for potentially resectable lesions if a tissue diagnosis will alter therapy. Endosonar-guided biopsy in expert hands appears to be the most reliable tissue sampling technique. Transcoelomic sampling methods should be reserved for those with un-resectable disease. All methods of cyto-histological diagnosis have high specificity but have a low negative predictive value. Therefore, potentially resectable lesions that are highly suspicious for malignancy should be explored even if pre-operative histology or cytology is negative.
authors.affiliation: Department of General Surgery, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa.
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
authors.forename: B A
authors.initials: BA
authors.lastname: Clarke
authors.forename: S R
authors.initials: SR
authors.lastname: Thomson
authors.forename: O J
authors.initials: OJ
authors.lastname: Garden
authors.forename: N G
authors.initials: NG
authors.lastname: Lazarus