What is the pancreas biopsy procedure and how is it done?

Pancreatic cancer is one of the most lethal types of cancer, and if it is operated on at an early stage, the life expectancy of the patient can be significantly prolonged. Unfortunately, in most cases, pancreatic cancer is detected at an advanced stage and biopsy is required to determine the type and structure of cancer and to plan treatments such as chemotherapy. 

Pancreatic biopsies are performed under ultrasound or computed tomography (CT) guidance. In very small-sized masses, a biopsy can also be taken under the guidance of endoscopic ultrasound, which we call EUS.

Before performing a pancreatic biopsy, bleeding and coagulation parameters such as hemogram, INR, APTT values are checked. Since the procedure is usually performed as tissue biopsy (cutting biopsy) or trucut biopsy, fine-needle aspiration biopsy is not preferred (due to diagnostic limitations). Drugs called blood thinners are discontinued on average 5 days before the procedure. Vascular access is opened. Blood values are checked. The procedure is performed under ultrasound or CT guidance. The procedure is usually done with a technique called the coaxial (double-needle system) technique. With ultrasound or CT, the place to enter the mass and the safe route of the needle are determined. After cleaning the skin, a local anesthetic is injected into the pancreatic mass under the skin until the area where the needle will pass. Pain relievers or sedative medications can be given through the existing vascular access. After the point of entry is determined, the needle that allows a thinner needle to pass through, which we call the coaxial needle, is inserted into the mass under ultrasound or CT guidance, avoiding the vessels. After it is seen that we are in the mass, the fine needle in the coaxial needle is removed and the appropriate automatic biopsy needle is inserted, and a piece of the mass is obtained from different parts 3-4 times with this needle. The obtained materials are evaluated by the pathologist during the process and if sufficient material is obtained, the process is terminated; In centers where onside pathology specialists are not available, the material is prepared appropriately and sent to the pathology laboratory. Fine-needle aspiration biopsy (FNAB) can also be performed in cases where a trucut biopsy cannot be taken safely because it is small in size and very close to the vessels.

Afterward, the automatic biopsy needle and then the coaxial needle is withdrawn and the control ultrasound or CT is taken, and bleeding, etc. check if there is. The skin is cleaned in a sterile way and covered with small gauze we call a sponge. The patient is kept under observation for about 4 hours and then discharged after clinical and, if necessary, blood test or ultrasound control.

The most important risk of pancreatic biopsy is bleeding. The risk of bleeding requiring blood transfusion or medical intervention is very low in the appropriate techniques and experienced hands.

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