Percutaneous needle biopsy of the pancreas: when should it be performed?

Is it appropriate for a good risk patient with a clinical history or imaging studies suggestive of an operable pancreatic neoplasm to undergo a percutaneous fine-needle aspiration biopsy (FNAB) prior to operation? A group of 118 patients who underwent percutaneous FNAB of the pancreas between 1987 and 1993 were evaluated retrospectively. The initial readings of the biopsies were positive for neoplasm in 78 patients and negative in 32. Four suspicious biopsies were included with the positive biopsies for analysis, and four unsatisfactory biopsies were added to the negative biopsies. Operation was performed on 57 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 neoplasia at operation. No operation was performed on 61 patients; 43 of these patients had a positive and 18 a negative FNAB. Three patients with a negative biopsy were treated with chemotherapy, and three subsequently died of pancreatic cancer. It was concluded that because the sensitivity of percutaneous FNAB is only 84% the procedure should be limited to patients suspected of having pancreatic cancer deemed technically inoperable or medically unsuitable for operation.