Diagnosis: Biopsy

Imaging tests are important in diagnosing suspected pancreatic cancer, but they cannot determine with 100% certainty if an abnormal mass is cancer or the type of cancer.  A tissue sample, or biopsy, of the tumor must be obtained and analyzed in order to determine the exact diagnosis.  A pathologist will look at tissue samples under a microscope to see if cancer cells are present.  If cancer cells are found, the shape, size, and arrangement of the cells may help the pathologist determine the type of pancreatic cancer.

Obtaining a conclusive biopsy can be difficult.  Fine-needle aspiration (FNA) is the most common biopsy procedure for suspected pancreatic cancer.  There are two methods for performing FNA:  the percutaneous approach and the EUS-guided approach.

During a percutaneous fine-needle aspiration, a local anesthetic and a cleaning solution are applied on the skin.  Then, a thin needle is inserted through the abdominal wall while the doctor uses the image from a CT scan or ultrasound to guide placement of the needle.  The needle is directed into the pancreas so that cells can be removed from the tumor.

The EUS-guided fine-needle aspiration method involves passing the needle down the throat through a special endoscope during an endoscopic ultrasound (EUS) imaging procedure.  This process involves imaging the tumor with ultrasound and inserting a thin needle through the stomach or duodenal wall immediately next to the pancreas.  Unlike percutaneous FNA, there is no pain with EUS-guided FNA.  EUS-guided fine-needle aspiration performed by a specially-trained and experienced doctor has been shown to be the most accurate biopsy method for the pancreas.

During an ERCP, other biopsy methods can be performed, such as a brush biopsy.  During this procedure, a small brush is introduced through the endoscope to rub off cells from the bile duct or pancreatic duct.  The chance of getting a diagnosis of pancreatic cancer with ERCP brushings is generally low compared to FNA methods.

In a forceps biopsy, forceps are passed through the endoscope and a small piece of tissue is removed.  A tissue sample can also be taken during surgery.

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only.  The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment.  If you are ill, or suspect that you are ill, see a doctor immediately!  The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.  080923