title: Preoperative tissue diagnosis for tumours of the pancreas.
abstract: BACKGROUND
  Preoperative biopsy of pancreatic lesions suspected of malignancy is controversial.
  
  
  METHODS
  A systematic Medline literature search was carried out. Diagnostic studies reporting quantitative preoperative pancreatic biopsy data were evaluated.
  
  
  RESULTS
  The analysis included 53 studies, mostly of a retrospective nature. Despite acceptable rates for sensitivity and specificity, the negative predictive value of percutaneous and endoscopic ultrasonography-guided biopsies was 60-70 per cent. Biopsy results were considered to be essential for directing non-surgical therapy in advanced disease. However, they were of limited value in planning the treatment of resectable solid or cystic tumours, or focal lesions in the setting of chronic pancreatitis.
  
  
  CONCLUSIONS
  Biopsy of suspected pancreatic malignancies with systemic spread or local irresectability is indicated for planning palliative or neoadjuvant therapy. Preoperative biopsy of potentially resectable pancreatic tumours is not generally advisable, as malignancy cannot be ruled out with adequate reliability.
authors.affiliation: Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hartwig
authors.forename: L
authors.initials: L
authors.lastname: Schneider
authors.forename: M K
authors.initials: MK
authors.lastname: Diener
authors.forename: F
authors.initials: F
authors.lastname: Bergmann
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: J
authors.initials: J
authors.lastname: Werner
mesh_terms: D001327:Autoimmune Diseases / Q000473:pathology; D044963:Biopsy, Fine-Needle; D016145:Endoscopy, Digestive System / Q000379:methods; D006801:Humans; D010179:Pancreas / Q000473:pathology*; D010181:Pancreatic Cyst / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010195:Pancreatitis / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D018084:Ultrasonography, Interventional