title: Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis.
abstract: OBJECTIVE
  To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions.
  
  
  METHODS
  CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form.
  
  
  RESULTS
  A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant.
  
  
  CONCLUSIONS
  CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Chiang J
authors.initials: CJ
authors.lastname: Tyng
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Maria Fernanda A
authors.initials: MF
authors.lastname: Almeida
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Paula N V
authors.initials: PN
authors.lastname: Barbosa
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Almir G V
authors.initials: AG
authors.lastname: Bitencourt
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: José Augusto A G
authors.initials: JA
authors.lastname: Berg
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Macello S
authors.initials: MS
authors.lastname: Maciel
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Felipe J F
authors.initials: FJ
authors.lastname: Coimbra
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Luiz Henrique O
authors.initials: LH
authors.lastname: Schiavon
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Maria Dirlei
authors.initials: MD
authors.lastname: Begnami
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Marcos D
authors.initials: MD
authors.lastname: Guimarães
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Zurstrassen
authors.affiliation: Chiang J Tyng, Maria Fernanda A Almeida, Paula N V Barbosa, Almir G V Bitencourt, José Augusto A G Berg, Macello S Maciel, Luiz Henrique O Schiavon, Marcos D Guimarães, Charles E Zurstrassen, Rubens Chojniak, Department of Imaging, AC Camargo Cancer Center, São Paulo, SP 09015-010, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: Chojniak
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
keywords: Computed tomography; Image-guided biopsy; Large-core needle biopsy; Needle biopsy; Pancreatic neoplasms
references.citation: Diagn Imaging Clin Med. 1985;54(2):88-91
references.pmid: 3886264
references.citation: Gastroenterol Res Pract. 2012;2012:908963
references.pmid: 23304130
references.citation: AJR Am J Roentgenol. 2006 Nov;187(5):1184-7
references.pmid: 17056903
references.citation: Br J Radiol. 2012 Jul;85(1015):e339-42
references.pmid: 21937619
references.citation: Anticancer Drugs. 2008 Jun;19(5):435-46
references.pmid: 18418211
references.citation: Gastrointest Endosc. 2005 Jun;61(7):854-61
references.pmid: 15933687
references.citation: Sao Paulo Med J. 2006 Jan 5;124(1):10-4
references.pmid: 16612456
references.citation: AJR Am J Roentgenol. 2006 Sep;187(3):769-72
references.pmid: 16928943
references.citation: Acad Radiol. 2009 Nov;16(11):1386-92
references.pmid: 19643636
references.citation: Acta Radiol. 1991 Nov;32(6):518-20
references.pmid: 1742134
references.citation: Am J Gastroenterol. 2000 Sep;95(9):2255-60
references.pmid: 11007226
references.citation: Zhonghua Zhong Liu Za Zhi. 2013 Aug;35(8):608-12
references.pmid: 24314220
references.citation: HPB (Oxford). 2004;6(3):144-53
references.pmid: 18333068
references.citation: World J Gastroenterol. 2009 Dec 21;15(47):5972-5
references.pmid: 20014462
references.citation: Acta Cytol. 2003 Sep-Oct;47(5):723-6
references.pmid: 14526668
references.citation: Radiology. 1993 Apr;187(1):99-104
references.pmid: 8451443
references.citation: Radiology. 2002 Jan;222(1):63-9
references.pmid: 11756706
references.citation: Surgery. 1996 Jul;120(1):75-9
references.pmid: 8693427
references.citation: Rofo. 2011 Sep;183(9):842-8
references.pmid: 21830181
references.citation: Br J Surg. 1989 Jul;76(7):706-7
references.pmid: 2670053
references.citation: Am J Gastroenterol. 2002 Nov;97(11):2701-2
references.pmid: 12425535
references.citation: Eur J Radiol. 2011 Dec;80(3):e488-90
references.pmid: 21030172
references.citation: Surg Gynecol Obstet. 1986 Dec;163(6):497-503
references.pmid: 3787424
references.citation: Clin Radiol. 2006 Dec;61(12):996-1002
references.pmid: 17097419
references.citation: Clin Imaging. 2015 Jan-Feb;39(1):62-5
references.pmid: 25043532
references.citation: J Gastrointest Surg. 2007 Jun;11(6):783-90
references.pmid: 17562121
references.citation: Rom J Gastroenterol. 2002 Dec;11(4):335-41
references.pmid: 12532207
references.citation: Endoscopy. 2012;44 Suppl 2 UCTN:E160-1
references.pmid: 22622721