The role of percutaneous biopsy in detection of pancreatic transplant rejection

The purpose of this study was to investigate the effectiveness and safety o f percutaneous pancreatic transplant biopsy guided by ultrasound alone or w ith a combination of computerized tomography (CT) for pancreas localization and ultrasound for needle placement. We also compare our finding on the us e of 18-gauge and 20-gauge needles for percutaneous pancreatic transplant b iopsy. In 42 attempted biopsies performed on 21 patients, two different imaging mo dalities were used. Twenty-seven attempted biopsies were performed under th e guidance of ultrasound alone, and 15 used a combination of ultrasound and CT. Of the 27 ultrasound-guided biopsies, 24 produced at least one sample adequate for histopathological analysis for an 89% biopsy success rate. Of the 15 biopsies guided by combined ultrasound and CT, 11 produced adequate samples for a 73% success rate. For all biopsies, an 83% success rate was f ound. In assessing the use of 18-gauge versus 20-gauge needles, 86 out of 1 10 tissue cores were adequate for histopathological analysis for a 78% yiel d. In 27 biopsy attempts using the 18-gauge needle, 75 tissue cores were ob tained, for an average of 2.8 cores per biopsy. Fifty-seven pancreas sample s collected using the 18-gauge needle were adequate for pathological evalua tion for a 76% yield. With 15 biopsy attempts using the 20-gauge needle, 35 tissue cores were collected, for an average of 2.3 cores per biopsy. Twent y-nine pancreas specimens obtained from using the 20-gauge needle were adeq uate for analysis far an 83% yield. No major complications occurred. Only o ne incidence of minor complication was reported for a 2% complication rate. The only complication was local, mild bleeding at the biopsy site in one c ase. Air within the transplant pancreas as revealed by post-biopsy scans an d streaky density appearing adjacent to the biopsy site occurred in a total of four cases and were not included. No complications were reported that r equired any invasive intervention. We conclude that percutaneous biopsy guided by ultrasound is a safe, simple , and effective method to detect pancreatic transplant rejection. Our resul ts for biopsies compare favorably with other reported techniques in terms o f effectiveness, complication rates, and ease of use. With its high success rate and low complications, ultrasound-guided percutaneous biopsy is an ex cellent method to sample pancreatic transplant.