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The role of preoperative biopsy in pancreatic cancer
D L Clarke1, B A Clarke, S R Thomson
1Department of General Surgery, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa.
Background:
Cyto-histological diagnosis of pancreatic pathology in the management of suspected pancreatic malignancy is re-evaluated in the light of evolving trends in management and tissue sampling.
Methods:
The literature on cyto-histological diagnosis of pancreatic pathology was reviewed over the period 1977-2003.
Results And Conclusion:
Endoluminal techniques of tissue sampling carry less risk of tumour seeding and are the sampling methods of choice for potentially resectable lesions if a tissue diagnosis will alter therapy. Endosonar-guided biopsy in expert hands appears to be the most reliable tissue sampling technique. Transcoelomic sampling methods should be reserved for those with un-resectable disease. All methods of cyto-histological diagnosis have high specificity but have a low negative predictive value. Therefore, potentially resectable lesions that are highly suspicious for malignancy should be explored even if pre-operative histology or cytology is negative.
