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. The doctor must obtain and analyze a tissue sample, or biopsy, of the tumor in order to determine the exact diagnosis. During a biopsy, a pathologist looks at the tissue samples under a microscope. If cancer cells are present, the shape, size and arrangement of the cells may help determine the type of pancreatic cancer. However, 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 FNA, a local anesthetic and a cleaning solution are applied on the skin. Then, a thin needle is inserted through the abdominal wall. The doctor uses the image from a CT scan or ultrasound to guide placement of the needle. The needle is directed into the pancreas to remove cells from the tumor.

The EUS-guided FNA 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 the EUS-guided approach. EUS-guided FNA performed by a specially-trained and experienced doctor is the most accurate biopsy method for the pancreas in most circumstances.

Other biopsy methods, such as a brush biopsy or forceps biopsy, can be performed during an ERCP. In a brush biopsy, 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 other methods.

In a forceps biopsy, forceps are passed through the endoscope and a small piece of tissue is removed. Forceps are an instrument used by a surgeon for grasping or extracting tissue.

Lastly, a biopsy sample can also be taken during surgery.

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