title: Trans-organ versus trans-mesenteric computed tomography-guided percutaneous fine-needle aspiration biopsy of pancreatic masses: feasibility and safety.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous fine-needle aspiration biopsy (FNAB) of pancreatic masses that traverses the gastrointestinal tract or solid viscera.
  
  
  METHODS
  From January 2002 to December 2012, 144 patients underwent 165 CT-guided biopsies of pancreatic masses. Biopsies were performed using a 21 or 22 G needle. Cytology reports, medical records, and procedure details for all patients were retrospectively reviewed to evaluate the biopsy route, complications, and diagnostic accuracy.
  
  
  RESULTS
  Trans-organ biopsies of pancreatic masses were safely performed via a direct pathway traversing the stomach (n = 45), colon (n = 14), jejunum (n = 4), or liver (n = 5). There were five self-limiting mesenteric haematomas along the biopsy route on immediate post-procedure CT and all patients remained asymptomatic. All haematomas occurred after a trans-mesenteric approach rather than passage through abdominal organs. Three patients had acute pancreatitis. There was no significant difference in complications and diagnostic yields between the groups. The sensitivity, specificity, positive predictive value, and negative predictive value of final FNAB cytology for malignancy were 98.3%, 100%, 100% and 71.4%, respectively. The overall accuracy was 98.4%.
  
  
  CONCLUSIONS
  Percutaneous FNAB using the trans-organ approach is a safe and effective technique to diagnose pancreatic malignancy.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: M-Y
authors.initials: MY
authors.lastname: Hsu
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: K-T
authors.initials: KT
authors.lastname: Pan
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-M
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: K-W
authors.initials: KW
authors.lastname: Lui
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Chu
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-F
authors.initials: CF
authors.lastname: Hung
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan. Electronic address: ma0389@cgmh.org.tw.
authors.forename: J-H
authors.initials: JH
authors.lastname: Tseng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*