During a biopsy, a small portion of a suspicious mass or cyst is removed and examined under a microscope for the presence of cancerous tissue. Imaging studies are important when identifying the presence of a suspicious mass, but cannot determine the presence of pancreatic cancer with absolute certainty. A biopsy can provide your doctor with an exact diagnosis. However, it is important to note that obtaining a conclusive tissue sample can be difficult. If cancerous tissue is found, the shape, size, and arrangement of the cells may help your doctor determine the type and stage of pancreatic cancer present.
There are several biopsy methods. Depending on the location of the mass and your personal health history, your doctor may use any of the following methods to provide the most accurate diagnosis.
Fine Needle Aspiration (FNA)
FNA is the most common biopsy procedure due to its safety and the reliability of its results. There are two ways to perform an FNA biopsy of the pancreas, either percutaneously (through the skin) or EUS-guided. When the percutaneous approach is used, a local anesthetic is applied to the skin and a long thin needle is inserted through the abdominal wall and into the pancreas. Imaging from a CT or ultrasound to guide the needle placement to ensure tumor cells are gathered.
In FNA with EUS guidance, the physician uses live ultrasound images to guide needle placement through the endoscope directly into the suspicious mass. The EUS-guided approach is our most frequently used method as it is painless for the patient and produces the most accurate results when performed by an experienced endoscopist.
In a brush biopsy, a small brush is inserted through the endoscope during an ERCP procedure and directly into your bile duct or pancreatic duct. Cells rub off onto the brush and can be examined using a microscope. However, the chance of getting a conclusive diagnosis using ERCP is low compared to FNA.
Laparoscopy is a procedure in which a small camera attached to a thin, lighted tube is inserted directly into the abdominal cavity through a small incision. It is performed with the patient under general anesthesia. This means the patient is completely asleep during the procedure and does not respond to verbal or physical prompts. By manipulating the camera, the doctor can directly view the pancreas and its surrounding organs. A tissue biopsy can be taken by passing a pair of forceps through the laparoscope.