A PERCUTANEOUS BIOPSY TECHNIQUE FOR PATIENTS WITH SUSPECTED BILIARY OR PANCREATIC-CANCER WITHOUT A RADIOGRAPHIC MASS

Background: Treatment of malignant pancreatic and/or biliary stricture s requires tissue diagnosis. Since cytologic brushings at endoscopic r etrograde cholangiopancreatography (ERCP) of these strictures has a po or sensitivity for malignancy (30-83%) (see ME Ryan, Gastrointestinal Endoscopy 1991;37(2):139-143; and MB Cohen, Wittchow RJ, Johlin FC, et al. Mod Pathol 1995;8:498-502), tissue diagnosis must be obtained by another route. We report our experience of percutaneous biopsy of mali gnant pancreatic and/or biliary strictures even when no radiographic m ass is present. Methods: At ERCP, five patients demonstrated pancreati c and/or biliary duct strictures, had atypical cytological brushings, and had their strictures stented. No mass to account for the stricture s could be identified on CT. These five patients underwent percutaneou s biopsy of the peristent material by CT within 10 days of the ERCP. R esults: Two patients had adenocarcinoma of the pancreas. One patient h ad malignant lymphoma and another had cholangiocarcinoma. One patient had inflammatory cells and was followed. Conclusions: If the diagnosis of malignancy cannot be made at the time of the ERCP sampling, then o ur experience suggests that a percutaneous biopsy should be performed even if a mass is not present using the stent as a target.