PERCUTANEOUS NEEDLE-BIOPSY OF THE PANCREAS - WHEN SHOULD IT BE PERFORMED

Is it appropriate for a good risk patient with a clinical history or i maging studies suggestive of an operable pancreatic neoplasm to underg o a percutaneous fine-needle aspiration biopsy (FNAB) prior to operati on? A group of 118 patients who underwent percutaneous FNAB of the pan creas between 1987 and 1993 were evaluated retrospectively. The initia l readings of the biopsies were positive for neoplasm in 78 patients a nd negative in 32. Four suspicious biopsies were included with the pos itive biopsies for analysis, and four unsatisfactory biopsies were add ed to the negative biopsies. Operation was performed on 37 of the 118 patients; 39 of these patients had a positive and 18 a negative FNAB. Of the 18 patients with a negative biopsy, 12 were proved to have neop lasia at operation. No operation was performed on 61 patients; 43 of t hese patients had a positive and 18 a negative FNAB. Three patients wi th a negative biopsy were treated with chemotherapy, and three subsequ ently died of pancreatic cancer. It was concluded that because the sen sitivity of percutaneous FNAB is only 84% the procedure should be limi ted to patients suspected of having pancreatic cancer deemed technical ly inoperable or medically unsuitable for operation.