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How to undergo a pancreas biopsy

Pancreas Biopsy

A biopsy is a procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.

A biopsy can confirmthat you have cancer. It can also let your doctor know what kind of pancreatic cancer you have. The biopsy may be done as a separate procedure, during another test, or during surgery to remove the pancreas. A biopsy is usually done in one of three ways.

  • Fine Needle Aspiration (FNA) biopsy
    The doctor uses a CT scan or endoscopic ultrasound (EUS) to locate the tumor. Then the doctor inserts a long, thin needle through your skin and into the tumor. Cells are removed through the needle.
  • Brush biopsy
    This biopsy may be done during a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) test. A long, thin tube called an endoscope is inserted through the mouth into the first part of the small intestine. The doctor then places a tiny brush through the endoscope and into your pancreatic or bile ducts. The brush rubs off some cells for testing.
  • Laparoscopy
    A surgeon makes a small cut on your abdomen to insert a thin tube with a light and a tiny video camera on the end. It lets your doctor see the pancreas and nearby areas. Your surgeon may make other small cuts to insert other tools to remove cells for testing. Learn more about laparoscopy.

Once the biopsy is done, a pathologist examines tissue samples under a microscope to check for cancer cells. It usually takes a few days for the results of your biopsy to come back.

How to Undergo a Pancreas Biopsy

An imaging test may find a tumor on the pancreas, which could be benign (non-cancerous) or malignant (cancerous). Getting a tissue sample of the tumor (called a biopsy) is the only way for your doctor to make an exact diagnosis.

Going in for a biopsy can cause a range of feelings, especially if you’re not sure what to expect. To feel more prepared and in control, here are some helpful things to know ahead of your biopsy.

  1. Your doctor will work with you to schedule the biopsy.

Your doctor may refer you to a gastroenterologist, who is a medical professional who specializes in the management of gastrointestinal disorders, including pancreatic cancers. In most cases, these are the specialists who perform the biopsy.

  1. There are a few ways to get a tumor biopsy. Your doctor will recommend the best type for you.

Your doctor will consider many factors, such as the tumor’s location and your current medical condition when choosing the most appropriate type for you.

A fine needle aspiration (FNA) or a core needle biopsy (CNB) may be used to retrieve the tissue needed for biopsy. An FNA is more common than a CNB. But because a CNB uses a larger needle, it can take a larger sample, which can be helpful if your doctor wants to run additional tests. There are multiple procedures used to perform these biopsies:

ERCP-guided biopsy: An endoscopic retrograde cholangiopancreatography (ERCP) is like an EUS, although the images produced are different. An ERCP also uses contrast dye, which makes it possible for the doctor to get an X-ray picture of the digestive tract to guide the needle.

Depending on the needs of the patient, other biopsy types, such as a brush biopsy or forceps biopsy, can be done during an ERCP in place of a needle.

CT-guided biopsy: After locating the tumor using a Computed Tomography (CT) test, a needle is injected through the skin into the pancreas to get the biopsy.

Surgery: If you’re already scheduled for surgery to remove the tumor, your doctor may be able to get the tissue sample then.

Contact Patient Central to learn more about specific biopsy types and when they are used.

  1. Patients may need more than one biopsy.

It may be difficult to get a conclusive, or definitive, biopsy to help determine the type of cancer you have.

If your result is inconclusive or does not match earlier imaging test results or your symptoms, you may want a second opinion. You have a right to seek a second opinion. The Pancreatic Cancer Action Network strongly recommends you seek a second opinion, as needed, at any point in your diagnosis.

  1. Biopsies can help guide treatment decisions.

In addition to determining if the tumor is cancerous, and the type of cancer you have, a biopsy may also uncover important, specific details about the tumor that will help your healthcare team determine your best treatment options.

For example, patients can choose to undergo molecular profiling. Molecular profiling is a test that examines a tumor’s tissue to get information about its makeup. Molecular profiling may find certain characteristics, or biomarkers, that suggest a tumor may be responsive to certain types of therapy, which can help inform personalized treatment decisions.

  1. Biopsy results can take anywhere from a few days to a few weeks.

After the procedure, the biopsy will be sent to a lab for examination. Most patients receive their results within a few weeks. Once the results are in, you can work with your healthcare team on next steps.

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How to Undergo a Pancreas Biopsy

What Is a Biopsy?

A biopsy is the removal of a tissue sample from the body for examination. The only way to decide if an abnormal mass or tumor is cancer is to get and analyze a biopsy. The biopsy may also show the type of pancreatic cancer. But not all biopsies give an exact diagnosis.

What Are the Challenges of Getting a Pancreas Biopsy?

The pancreas’ location is the biggest challenge in getting a biopsy. The pancreas sits in the back of the abdomen, surrounded by the stomach, small intestine, liver and spleen. Since it is not close to the surface, it is hard for the doctor to get to the pancreas to take a sample.

Biopsies Without Surgery

In the past, the only way to get a tissue sample from the pancreas was during surgery. Now, most doctors biopsy the pancreas using nonsurgical procedures like endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP). But if the patient is already scheduled for surgery to remove the tumor, the doctor will likely get the tissue sample then.

Types of Nonsurgical Biopsies

The most common way to get pancreatic tumor samples is called fine-needle aspiration (FNA). During an FNA, a needle is inserted into the tumor to get cells from the tumor.

A core needle biopsy (CNB) uses a larger needle than an FNA, so it can get a larger sample.

While FNA is currently more common for diagnosis, patients who get molecular profiling may need a CNB to get enough tissue for testing. CNB is commonly used in clinical trials, as well. Contact Patient Central to learn more about when a CNB should be considered.

FNAs and CNBs can happen during an endoscopic ultrasound (EUS). An EUS-guided FNA is the most exact biopsy method for the pancreas. When pancreatic cancer spreads to other organs, such as the liver, a biopsy may be performed on the metastatic (new) tumor. This is commonly done through the abdomen.

Other biopsy types, such as a brush biopsy or forceps biopsy, can be done during an endoscopic cholangiopancreatography (ERCP). In a brush biopsy, a small brush passes through the endoscope to rub off cells from the pancreas. ERCP brushings are not as accurate as other methods for diagnosing pancreatic cancer.

In a forceps biopsy, forceps (tongs) pass through the endoscope to get a small piece of the tumor.

What Are the Advantages of Getting a Biopsy Without Surgery?

  • Does not require general anesthesia
  • Recovery period is short
  • Patient usually goes home the same day
  • Serious side effects are rare

What Are the Disadvantages?

Sometimes, the needle or brush used in the biopsy procedure misses the target. This can lead to a noncancerous diagnosis even when cancer cells are present in the pancreas.

What Happens After the Biopsy?

A pathologist analyzes the tumor sample under a microscope to look for cancer cells. Even the most experienced pathologists can have trouble finding pancreatic cancer cells. Sometimes, even if the pathologist thinks the sample is cancerous, it may not be possible to rule out an unusual noncancerous growth, such as an intraductal papillary mucinous neoplasm (IPMN).

What Should I Do if My Biopsy Is Inconclusive?

If the pathology report is inconclusive or does not match earlier imaging test results or the patient’s symptoms, you may want a second opinion. A diagnosis of a rare tumor type, like a pancreatic neuroendocrine tumor, is also a good reason to get a second opinion.

Since treatment depends on the specific type of pancreatic cancer, you should have a confirmed diagnosis before starting treatment. And patients often need an exact diagnosis to join a clinical trial.

If the tumor can be removed by surgery, and other tests and symptoms suggest pancreatic cancer, the surgeon may decide to go on with surgery.

We’re Here to Help

For free, in-depth and personalized resources and information on the diagnosis and treatment of pancreatic cancer, contact Patient Central.

Related Topics

Diagnosis

See how pancreatic cancer is found, including tests done.

Treatment Types

Understand pancreatic cancer treatment options.

Monitoring Pancreatic Cancer

Learn about the CA 19-9 blood test used to monitor a patient’s cancer and treatment.

Recently Diagnosed

Get key information especially helpful for recently diagnosed patients.

Information reviewed by PanCAN’s Scientific and Medical Advisory Board, who are experts in the field from such institutions as University of Pennsylvania, Memorial Sloan-Kettering Cancer Center, Virginia Mason Medical Center and more.

How to Undergo a Pancreas Biopsy

There are different ways of taking a sample of cells (biopsy) to check for pancreatic cancer.

Why you need a biopsy

The most sure way of diagnosing pancreatic cancer is by taking a sample of cells (biopsy) and looking at them under a microscope.

Your doctor takes a biopsy by putting a needle into the area of suspected cancer.

Specialists don’t usually take biopsies if they think that the cancer could be removable with surgery (resectable). In that case, your diagnosis will be made by the doctor examining you and reviewing your scans and tests. A confirmed diagnosis can be made when the tumour is removed during surgery.

Your specialist might want to do a biopsy if you have a cancer that can’t be removed with surgery. Then they can find out exactly what kind of cancer it is and whether you can have treatment to slow down its growth.

Different ways of taking a biopsy

There are several different ways your doctor can take a biopsy. The type your doctor uses will depend on the position of the tumour in the pancreas.

Biopsy with endoscopic ultrasound (EUS)

Endoscopic ultrasound is an ultrasound scan done from inside the body. Your doctor may call it endoluminal ultrasound or by the initials EUS.

The doctor puts a flexible tube called an endoscope down your throat. It contains a small ultrasound probe. The ultrasound picture helps the doctor to see any areas that might be cancer. They can then guide a small needle into these areas to take the biopsy.

Biopsy during an ERCP

ERCP stands for endoscopic retrograde cholangio pancreatography. It shows the liver, bile ducts, pancreas and gallbladder. Your doctor passes a tube called an endoscope down your throat to take x-rays of the pancreas and gallbladder. The endoscope has a small camera and light at the end.

The doctor can see if there are any growths or other abnormal looking areas in the pancreas or gallbladder and can take biopsies.

Ultrasound or CT guided biopsy

You doctor can use an ultrasound or CT scan to see exactly where the tumour is. You have a local anaesthetic injection in the skin over the pancreas so that the area goes numb. Your doctor then puts a fine needle through the skin and into the tumour. They can take out a small piece of tissue.

You feel pressure when the needle goes in, but it shouldn’t be painful because of the local anaesthetic.

Using a tube put through the skin of your tummy (laparoscopy)

This test is called a laparoscopy. Your doctor uses a thin, flexible tube called a laparoscope to look inside the tummy (abdomen). The tube has a light and camera attached.

You are most likely to have this done under a general anaesthetic. Once you are asleep, your doctor makes several small cuts (incisions) in the skin of your abdomen. They pump gas into the abdomen so they can see the organs in the abdomen more clearly. This gas won’t do any harm and gradually disappears after the test.

Your doctor might use an ultrasound through the laparoscope. This helps to show exactly where the tumour is. Your doctor can then take a biopsy.

After this test is over, you have stitches or steristrips holding the wounds closed. The cuts heal within a week or so.

During a small operation (laparotomy)

This test is called a laparotomy. Your surgeon makes a cut in the skin of your tummy (abdomen) to take a tissue sample from the pancreas.

Today this is rare, and you are more likely to have a laparoscopy because it is a much smaller operation. You usually have to stay in hospital for a few days after a laparotomy.

Some surgeons send the biopsy to the laboratory while you are still under anaesthetic. If the laboratory confirms that you have pancreatic cancer your surgeon might carry on and remove the cancer.

Possible risks

This is a safe procedure but your nurse will tell you who to contact if you have any problems afterwards. Your doctors will make sure the benefits outweigh the possible risks.

Other tests

You might have other tests to diagnose the cancer or to find out whether it has spread.

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How to Undergo a Pancreas Biopsy

A pancreatic biopsy is an outpatient surgical procedure, during which sections of the pancreas are removed for pathological examination. In most cases, pancreatic biopsies are done when pancreatic cancer is suspected; however, there are other pancreatic disorders and diseases that can prompt a biopsy. The procedure is usually a same-day surgery.

How to Undergo a Pancreas BiopsyProblems with the pancreas may be detected via ultrasound.

A pancreatic biopsy is typically ordered after a pancreatic mass is discovered through an ultrasound or MRI imaging. Though some imaging can discern a tumor from a cyst or scar tissue, others cannot. In addition, the only way to accurately determine whether a pancreatic mass is benign rather or malignant, or noncancerous rather than cancerous, is through a pancreatic biopsy.

The surgeon uses ultrasound, CT, or x-rays to locate the mass. Once it is located, localized anesthetic is used to numb the area for the needle, which is inserted through the skin and guided into the mass. The needle draws out a sample of the pancreas tissue for examination. A lab determines the biopsy results and relays them to the physician, who shares them with the patient.

How to Undergo a Pancreas BiopsyThe pancreas gland aids in digestion and produces insulin.

The patient is instructed not to eat or drink for the eight hours leading to the test. Patients should discuss prescribed or over-the-counter medication with the pre-operation health care provider to determine whether it should still be taken that morning. Once the paperwork is complete, the patient is prepped for the procedure. After the patient is registered, the pre-op preparation and biopsy typically take a total of 1.5 to 2 hours.

How to Undergo a Pancreas BiopsyA pancreas that is not performing correctly may cause bloating and watery stools.

For patients who are anxious, the physician will prescribe medication to help them relax. Depending on the patient, a pancreatic biopsy procedure can cause mild to moderate discomfort without anti-anxiety medication. Following the procedure, the patient’s family usually meets with the physician for a preliminary report, and then the actual lab report arrives a few days later with official results.

A keyhole surgery is another type of pancreatic biopsy. This procedure is completed while the patient is under general anesthesia. The surgeon guides a telescope instrument through a cut in the patient’s abdominal area and connects the instrument to a video screen. This procedure allows the surgeon to view the pancreas and surrounding organs. It also allows the surgeon to measure the tumor.

After the biopsy, most patients return home the same day. They are told to rest as needed and return to normal daily duties within a day or two. Sometimes the physician will restrict lifting or activities that require physical exertion for a few days to a week.

How to Undergo a Pancreas BiopsySections of the pancreas are removed during a pancreatic biopsy when cancer is suspected.

Authors

  • PMID: 26742294

Abstract

Objective: To describe the complications rate related to percutaneous ultrasound-guided pancreas allograft biopsy using an N16 Gauge needle.

Material and methods: In this retrospective study, the results of transplanted pancreas biopsies were analyzed in the Hospital Italiano de Buenos Aires between 1997 and 2012. In all patients, the indication for the procedure was a suspected rejection. After verifying the lack ofcontraindications, a percutaneous biopsy ofthe transplanted pancreas guided by ultrasound using an N16 Gauge needle was performed. A pathologist immediately evaluated the samples in order to establish that the material obtained was adequate. The complications were documented.

Results: . A total of92 pancreas percutaneous biopsies were performed in 47 patients in the Interventionism service of the Hospital Italiano de Buenos Aires. In 86% ofthe biopsies two samples were taken and in the 14% remaining only one. It was possible to reach a diagnosis in 100% of the biopsies. Only two patients presented complications: a post-puncture pancreatic fistula that healed with conservative treatment and an intense post-puncture pain with vasovagal reaction that reverted with the increase of venous return.

Conclusion: Our results with the 16G needle are similar to those reported by other authors that used needles with lower gauge (18G or 20G). Thus, we can interpret that the percutaneous biopsy of transplanted pancreas under ultrasound guide with N16 Gauge needle is a safe (2.2% of complications) and efficient technique for the histopathological diagnosis of rejection (100%).

A thorough and accurate cancer diagnosis is the first step in developing your pancreatic cancer treatment plan. Our cancer doctors will perform a comprehensive array of tests designed for diagnosing pancreatic cancer and determining the type and stage of the disease. During your diagnostic evaluation, you may undergo a number of tests, such as a laparoscopy, chest X-ray or bone scan, to determine if the cancer has grown beyond the pancreas. The test results help us formulate treatment recommendations tailored to you and your needs.

Common evaluations designed for diagnosing pancreatic cancer include:

Biopsy

A biopsy is an important part of formulating a pancreatic cancer diagnosis. During a biopsy, doctors remove a small amount of tissue from the pancreas. An endoscopic ultrasound-guided fine needle aspiration biopsy is a common procedure when pancreatic cancer is suspected.

Endoscopic retrograde cholangiopancreatography (ERCP)

We use ERCP for pancreatic cancer to remove samples of cells or fluid to be viewed under a microscope, to relieve an obstruction of the bile duct, or to place a stent into a narrowed duct to help keep it open. We may use a SpyGlass endoscope, which has a fiber-optic probe attached to a camera that allows us to identify obstructions in the bile duct.

Imaging tests

CT scan: A CT scan for pancreatic cancer uses X-ray images to present detailed images of the pancreas. With the GE Discovery PET/CT 600 Scanner, a four-dimensional CT scanner that produces detailed cross-sectional X-ray images of structures within the body, our radiologists are better able to plan treatment in accordance with patients’ breathing patterns.

MRI: When diagnosing pancreatic cancer, our team may use MRI, which uses radiofrequency waves to create detailed cross-sectional images of the pancreas.

Ultrasound: An ultrasound for pancreatic cancer uses sound wave technology to provide echoes of the pancreas. The echoes that pancreatic tumors produce are different from those of healthy tissues. In some cases, endoscopic ultrasound may be used. This technology allows us to view high-quality images of the pancreas and deliver treatment directly to a pancreatic mass.

X-ray: An X-ray for pancreatic cancer constructs images of inside the body to detect and stage the disease.

Percutaneous transhepatic cholangiography: During this test for pancreatic cancer, our doctors inject dye into the liver to closely examine bile ducts that have possibly been altered by the disease.

Angiogram: With this test, our doctors inject dye into an artery to outline the blood vessels and then take images to reveal how, or whether, blood flow in a particular area is blocked by a tumor.

Other imaging tests include:

Lab tests

We may use laboratory tests to check for tumor-associated antigens, such as an elevated CA 19-9 (carbohydrate antigen 19-9) level. We may also check billirubin levels because high levels may indicate blocked bile ducts.

Other lab tests may include:

Advanced genomic testing: Genomic testing examines a tumor on a genetic level to look for the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell’s genome, we can better understand what caused the tumor and tailor treatment based on these findings.

Nutrition panel: With this test, we evaluate patients for deficiency of nutrients, such as vitamin D and iron. The test helps us identify the nutrients patients need replaced or boosted to support their quality of life.

Laparoscopy

During a laparoscopy for pancreatic cancer, our doctors make a small incision in the abdomen to closely explore the normality of the area. This may be a useful tool for staging pancreatic cancer, and to determine whether the cancer has metastasized to the liver.

What is a biopsy of the pancreas?

A biopsy of the pancreas is a diagnostic procedure where a sample of pancreatic tissue is removed and examined to determine if you have cancer. A biopsy of the pancreas can be performed during surgery to remove the pancreas or as a stand-alone procedure.

Types of pancreatic biopsies

There are three ways to perform a pancreatic biopsy:

Fine needle aspiration (FNA) biopsy

During a fine needle aspiration biopsy, also known as percutaneous biopsy, your doctor will use a CT scan or endoscopic ultrasound to locate the pancreatic tumor. Once the tumor is located, cells are removed through a long, thin needle that is inserted into the tumor within the pancreas.

Endoscopic biopsy

During an endoscopic biopsy, your doctor will insert an endoscope with a camera on the end into the small intestine through the mouth. Depending on your case, your doctor may use an endoscopic ultrasound or endoscopic retrograde cholangiopancreatography to obtain a sample of pancreatic or bile duct cells. Then, he or she will thread a tiny brush through an endoscope into the pancreatic or bile ducts to rub off some of the pancreatic cells so they can be tested.

Surgical biopsy (laparoscopy)

During a surgical biopsy, your surgeon will insert a tube that has a light and video camera on it into the abdomen. This procedure allows your doctor to view the pancreas in more detail. Once your doctor has located the tumor with the camera, he or she will determine the best way to collect cells to evaluate for cancer. A laparoscopy is the most common form of surgical biopsy.

Who is a candidate for biopsy of the pancreas?

Your doctor may order a biopsy of the pancreas if he or she suspects you have pancreatic cancer or to understand what type of pancreatic cancer you have.

Risks associated with a biopsy of the pancreas

Complications associated with a biopsy of the pancreas are rare.

Results from a biopsy of the pancreas

After the test, your tissue sample will be sent to a Mercy Health pathologist for examination. The pathologist will review the sample to determine if there are cancer cells in the pancreas and if so, what type of pancreatic cancer you have.

Results from a biopsy of the pancreas will be sent to your doctor a few days after the test. Your doctor will either call or schedule an appointment to review the results.

How to Undergo a Pancreas Biopsy

In some cases, your doctor may decide that he or she needs a sample of your tissue or your cells to help diagnose an illness or identify a cancer. The removal of tissue or cells for analysis is called a biopsy.

While a biopsy may sound scary, it’s important to remember that most are entirely pain-free and low-risk procedures. Depending on your situation, a piece of skin, tissue, organ, or suspected tumor will be surgically removed and sent to a lab for testing.

If you have been experiencing symptoms normally associated with cancer, and your doctor has located an area of concern, he or she may order a biopsy to help determine if that area is cancerous.

A biopsy is the only sure way to diagnosis most cancers. Imaging tests like CT scans and X-rays can help identify areas of concerns, but they can’t differentiate between cancerous and noncancerous cells.

Biopsies are typically associated with cancer, but just because your doctor orders a biopsy, it doesn’t mean that you have cancer. Doctors use biopsies to test whether abnormalities in your body are caused by cancer or by other conditions.

For example, if a woman has a lump in her breast, an imaging test would confirm the lump, but a biopsy is the only way to determine whether it’s breast cancer or another noncancerous condition, such as polycystic fibrosis.

There are several different kinds of biopsies. Your doctor will choose the type to use based on your condition and the area of your body that needs closer review.

Whatever the type, you’ll be given local anesthesia to numb the area where the incision is made.

Bone marrow biopsy

Inside some of your larger bones, like the hip or the femur in your leg, blood cells are produced in a spongy material called marrow.

If your doctor suspects that there are problems with your blood, you may undergo a bone marrow biopsy. This test can single out both cancerous and noncancerous conditions like leukemia, anemia, infection, or lymphoma. The test is also used to check if cancer cells from another part of the body have spread to your bones.

Bone marrow is most easily accessed using a long needle inserted into your hipbone. This may be done in a hospital or doctor’s office. The insides of your bones cannot be numbed, so some people feel a dull pain during this procedure. Others, however, only feel an initial sharp pain as the local anesthetic is injected.

Endoscopic biopsy

Endoscopic biopsies are used to reach tissue inside the body in order to gather samples from places like the bladder, colon, or lung.

During this procedure, your doctor uses a flexible thin tube called an endoscope. The endoscope has a tiny camera and a light at the end. A video monitor allows your doctor to view the images. Small surgical tools are also inserted into the endoscope. Using the video, your doctor can guide these to collect a sample.

The endoscope can be inserted through a small incision in your body, or through any opening in the body, including the mouth, nose, rectum, or urethra. Endoscopies normally take anywhere from five to 20 minutes.

This procedure can be done in a hospital or in a doctor’s office. Afterward, you might feel mildly uncomfortable, or have bloating, gas, or a sore throat. These will all pass in time, but if you are concerned, you should contact your doctor.

Needle biopsies

Needle biopsies are used to collect skin samples, or for any tissue that is easily accessible under the skin. The different types of needle biopsies include the following:

  • Core needle biopsies use medium-sized needle to extract a column of tissue, in the same way that core samples are taken from the earth.
  • Fine needle biopsies use a thin needle that is attached to a syringe, allowing fluids and cells to be drawn out.
  • Image-guided biopsies are guided with imaging procedures — such as X-ray or CT scans — so your doctor can access specific areas, such as the lung, liver, or other organs.
  • Vacuum-assisted biopsies use suction from a vacuum to collect cells.

Skin biopsy

If you have a rash or lesion on your skin which is suspicious for a certain condition, does not respond to therapy prescribed by your doctor, or the cause of which is unknown, your doctor may perform or order a biopsy of the involved area of skin. This can be done by using local anesthesia and removing a small piece of the area with a razor blade, a scalpel, or a small, circular blade called a “punch.” The specimen will be sent to the lab to look for evidence of conditions such as infection, cancer, and inflammation of the skin structures or blood vessels.

Surgical biopsy

Sometimes a patient may have an area of concern that cannot be safely or effectively reached using the methods described above or the results of other biopsy specimens have been negative. An example would be a tumor in the abdomen near the aorta. In this case, a surgeon may need to get a specimen using a laparoscope or by making a traditional incision.

How to Undergo a Pancreas Biopsy

Most common conditions

Inflammation of the Pancreas / Pancreatic Cancer / Pancreatic Tumor

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1 Veterinary Answers

Most common conditions

Inflammation of the Pancreas / Pancreatic Cancer / Pancreatic Tumor

How to Undergo a Pancreas Biopsy

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What is Pancreatic Biopsy?

A biopsy for cats is the act of removing samples of tissues or cells from one area of the body for microscopic analysis. A biopsy can be taken from any area in the cat’s body, but a pancreatic biopsy is removing a small portion of the pale pink organ known as the pancreas. The pancreas is responsible for releasing digestive enzymes that break down food your cat eats and for releasing hormones that control a cat’s blood sugar levels (glucose). If your veterinarian suspects your cat’s pancreas is not functioning properly, he or she may request a pancreatic biopsy procedure.

There are several types of biopsies available for your veterinarian to choose from to conduct a pancreatic biopsy in cats. The types of biopsies that are commonly used for felines include:

Fine Needle Aspiration Biopsy

Uses a thin needle attached to a syringe to aspirate a small sample of tissues from a suspicious area.

Core Needle Biopsy

Uses a hollow needle to withdraw cylinders of tissue from a suspicious area.

Stereotactic Core Needle Biopsy

Uses a computer connected to x-ray equipment to pinpoint a suspicious area inside the abdomen for the needle to aspirate from.

Biopsy Punch

A device takes a small sample of tissue for analysis.

Surgical Biopsy

There are two types of surgical biopsies, incision biopsy and excisional biopsy.

  1. Incision Biopsy: removal enough of the tissue to make a diagnosis.
  2. Excisional Biopsy: removal of entire tumor or suspected area.

Pancreatic Biopsy Procedure in Cats

Prior to conducting the pancreatic biopsy procedure, the veterinarian will complete a physical examination and review the feline’s medical history. As radiographs, a CT scan, MRI or ultrasound was likely what provoked the need for a biopsy, the results of these test will be reviewed. The cat’s blood and urine will be analyzed to ensure she/he is healthy enough to undergo the procedure, as well as general anesthesia.

  1. The feline will be injected with a pre-anesthetic drug or sedative.
  2. The feline will have a tracheal tube placed to infuse oxygen and a gas anesthetic. The feline will be taken to the surgical/biopsy area.
  3. Oxygen and gas anesthetic will be attached to the tube, where the rate of infusion will be calculated based on the cat’s weight and age, as well as the duration of the procedure.
  4. The area above the pancreas will be shaved and cleaned with a chlorhexidine and iodine solution to sterilize the area.
  5. The veterinarian will accomplish the pancreatic biopsy type as planned. A biopsy may be accomplished using a scalpel blade, needle, or punch.
  6. Once the sample of tissues are taken from the feline, the sample is given to the veterinary technician to prepare for the lab and the incision site is closed. The biopsy site may be stitched, stapled or glued closed depending on the veterinarian’s preference.

Efficacy of Pancreatic Biopsy in Cats

The efficacy of a pancreatic biopsy in cats depends on the type of biopsy procedure used, as some procedures do not take enough cellular material to reach a proper diagnosis. The fact that the pancreas is an internal organ makes performing a biopsy difficult, but when a biopsy is taken successfully, the act of conducting a biopsy is highly effective in diagnosing a suspicious area.

Pancreatic Biopsy Recovery in Cats

After the biopsy procedure, the cat will be allowed to return home, but activities will be restricted until the incision site has healed. An Elizabethan collar will likely be sent home with the patient to prevent chewing, licking, or manipulating the affected area. Results of the biopsy are typically available 1-2 weeks after the procedure.

How to Undergo a Pancreas Biopsy

Cost of Pancreatic Biopsy in Cats

The estimated cost for a pancreatic biopsy in cats is roughly $150, but greatly depends on the type of biopsy performed. Initial workups, such as the initial examination, blood work, radiographs and other diagnostic imagery can bring your total cost anywhere from $450 to $700.

Cat Pancreatic Biopsy Considerations

A biopsy can provide vital information about your cat’s condition to the veterinarian, but manipulating the pancreas by taking a biopsy sample can worsen the problem. Your cat may require hospitalization if her/his response to having a pancreatic biopsy is negative.

Pancreatic Biopsy Prevention in Cats

The need for a biopsy in a cat cannot always be prevented. A biopsy is often necessary to identify suspicious tissues and it is not until the biopsy is performed will a cat owner known how to prevent the feline illness.

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A research team from Taiwan assessed the safety, yield, and clinical utility of percutaneous transgastric computed tomography-guided biopsy in patients with pancreatic masses. They found that percutaneous transgastric biopsy of the pancreas in selected patients with a combination of a 17-gauge introducer needle and an 18-gauge biopsy gun can be safe and has a high successful rate.

It is reasonable to obtain a histological diagnosis before treating patients who have pancreatic masses and are unsuitable or unwilling to undergo surgery. As the pancreas is a deep seated organ surrounded by other vital structures, it is a challenge for the physician to obtain an adequate specimen for histological examination. Endoscopic ultrasound-guided biopsy of pancreatic masses has been proved to be a safe and effective method. However, if the hospital has no such facilities or patients are unwilling or intolerant of the procedure, computed tomography (CT)-guided biopsy is an alternative method.

A research article to be published on December 21, 2009 in the World Journal of Gastroenterology addresses this question. A research team from Taiwan reviewed 34 CT-guided biopsies in patients with pancreas mass, of whom 24 (71%) had a direct path to the mass without passing through a major organ.

Their results showed tumor tissues were obtained in nine pancreatic biopsies, and histologic specimens for diagnosis were obtained in all cases. An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis. No delayed procedure-related complication was seen during the survival period of all patients.

They drew a conclusion that it is feasible to perform transgastric biopsy of a pancreatic lesion using a large needle.

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How to choose the best Pancreas Biopsy doctors in the world?

The specialist’s CV contains details about doctor’s expertise and work experience, education, scientific research, and languages spoken. Compare information on several specialists, read carefully about their experience, success rates and methods they apply. Make sure the chosen doctor has a relevant experience in the treatment of a medical issue you are looking for. Read reviews of patients who had a consultation with the chosen specialist.

Famous Pancreas Biopsy doctors have vast experience, continue education constantly, participate in professional associations and have positive feedback from patients treated.

What is the cost of a doctor’s consultation?

The price for the consultation on Pancreas Biopsy varies between experts and depends on some factors as:

the country of practicing

the clinical experience and reputation

the medical degree and educational background

the doctor’s workload

medical developments, proprietary techniques used, and awards if any.

How to make an appointment with a chosen doctor?

To schedule your visit, just submit a request on Bookimed.com. Our coordinator will contact you to discuss the time and details of the appointment, so everything will go fast and comfortable.

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In order to evaluate the severity of pancreatitis and pancreatic cancers, your doctor will likely recommend a pancreas biopsy. A pancreas biopsy can help assess how a tumor is affecting your pancreas’ natural function, allowing your doctor to determine next steps for your treatment and well-being.

What Can I Expect?

What is a Pancreas Biopsy?

A biopsy is a procedure that removes tissue from an area of concern in the body. The extracted tissue is examined by interventional specialists to determine the presence or cause of a disease. When it comes to the pancreas, biopsies are often used to evaluate the presence and stage of pancreatic cancer.

Pancreas biopsies are performed during an endoscopic ultrasound using a fine needle. The ultrasound carefully images the pancreas while the fine needle is used to extract a sample of tissue.

What Can I Expect?

During your procedure, your doctor will use a fine needle as the main biopsy device and an endoscopic ultrasound to guide the needle.

In order to image your pancreas, an endoscope (a thin and responsive tube) with a tiny camera at the end is inserted into your body via the mouth. As your doctor examines your abdomen through a monitor, the ultrasound transducer within the endoscope emits high-frequency sound waves to your pancreas.

Using the detailed images of the pancreas provided by the transducer, your surgeon will insert the biopsy device into the pancreas and extract tissue from the suspicious area.

After your biopsy procedure, a pathologist examines the extracted tissue specimen to detect any complications. If cancer is present, the pathologist can then look at the cancer’s characteristics and formulate a precise diagnosis.

At Providence, our surgeons, nurses and caregivers work to ensure your procedure is done in a comfortable and calming environment to avoid complications.

How to Undergo a Pancreas Biopsy

For eligible patients, surgery is the best option for long term survival of pancreatic cancer. Data show high volume surgeons at high volume hospitals have greater success rates and fewer complications. The Pancreatic Cancer Action Network (PanCAN) strongly recommends you have a high volume pancreatic surgeon (more than 15 surgeries per year) perform the surgery.

Below are five more key facts about pancreatic cancer surgery.

    About 20 percent of pancreatic cancer patients are eligible for surgery at diagnosis. Since pancreatic cancer symptoms are often vague and the pancreas is located deep within the body, the disease is often diagnosed in its later stages.

In addition, a significant number of patients who are eligible for surgery are told they are ineligible. PanCAN strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.
There are different types of surgeries that a pancreatic cancer patient can undergo. The most common surgery is known as the Whipple procedure (pancreaticoduodenectomy). The Whipple is performed on patients whose tumor is confined to the head of their pancreas.

Pancreatic cancer patients may also undergo a distal pancreatectomy or complete pancreatectomy, which involve removing some or all of their pancreas. The appropriate surgery is selected based on the size and location of the tumor within the patient’s pancreas and other eligibility criteria.

  • Surgery may be offered alongside other treatments. Pancreatic cancer patients may receive chemotherapy and/or radiation or other treatment types before surgery, known as neoadjuvant therapy, or after surgery, known as adjuvant therapy.
  • The tissue removed during surgery can help inform future treatment decisions. If you are eligible for surgery, PanCAN strongly recommends calling Patient Central to discuss the benefits of molecular profiling.

    Tissue taken during surgery (or from a biopsy) can be molecularly profiled to identify the changes in genes and proteins that are present in a patient’s tumor. There are some tumor characteristics, known as “actionable alterations,” that can predict a patient’s response to certain types of treatments.
    Surgery can be supportive (palliative), too.Palliative procedures are performed to alleviate (palliate) symptoms. They do not involve the complete removal of the tumor. Palliative procedures may relieve symptoms of jaundice, pain or nausea and vomiting that are caused by blockage of the bile duct and/or duodenum.

    The most common palliative procedures for pancreatic cancer are biliary bypass surgery, gastric bypass surgery and biliary or duodenal stent insertion.

    Check out our recent Surgical Advances for Pancreatic Cancer educational webinar.

    Ranking of hospitals and doctors, patient reviews, prices, and information from medical centers

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    How to Undergo a Pancreas Biopsy

    Royal Brompton and Harefield NHS Foundation Trust is the largest British center, specializing only in the diagnosis and treatment of heart and lungs diseases. The Hospitals treat both children and adults.

    How to Undergo a Pancreas Biopsy

    Everything, it’s a Good place to and there is plenty benefits. Most are importantly it is located in the heart of London

    I was appalled at how dirty the entrance lobby was yesterday. only 1 dirty looking hand sanitised hidden by the reception desk who were less than amenable when approached for directions. dirty cafe are and no sign if hand washing facilities and only 1 hand sanitiser. men’s toilets closed. disabled toilets locked. I was with 2 elderly people who had difficulty walking. no sign of any staff to ask for help with wheelchair assistance. Dirty seating area with torn seats. all in all a hive of filth and mist likely rife with bacteria. No sign of how the risk of coronavirus was being tackled. No sign of bins to put dirty tissues in. compared to hidoitsls in Europe UCL is a very poor exmple of the standards the NHS portends to.

    The staff at this hospital are the best NHS staff I have ever been treated by. Not only are they kind and empathetic but they are also incredibly knowledgable and very focused and hard working. I was admitted to the hospital alone and afraid and my illness was taken seriously and the staff on hand were so sweet and kind to me. The Dr’s showed a level of genuine concern I have never seen. The hospital ward I was on EGA was immaculate and clean and the staff were very good at following hygiene protocol. Always washing their hands and even hiding needles as they passed from one patient to another presumably to prevent the other patients from being unnerved. They treated me like a family member and I felt I was in the best hands. Fantastic hospital.

    Amazing hospital where we have great teamwork.

    Hi everyone, I just wanted to share something that has happened to me over the last week. We are all quick to moan about the NHS but I have had an experience that has blown me away. Last week I had a referral appointment with Prof Mundy who is a urologist based at University College Hospital London Westmoreland Street. At the appointment I updated him as to my current position with my Artificial Urinary Sphincter and the trials and tribulations that I had been going through o…ver the last couple of months. His immediate focus was drawn to the fact that there may have been cuff erosion and he was concerned that the pain, swelling and discomfort I was having may be signs of this and he was extremely concerned as I could not self catheterise either and I had had a supra pubic catheter put in earlier in the week at Southampton as I had gone into retention. Within ten minutes of him assessing me he had arranged for me to be admitted the following day for a urgent cystoscopy and investigation with the possibility of the removal of the Artificial Urinary Sphinctre under general anaesthetic. I was sent straight to pre-op assessment and bloods and other tests were done straight away. Before leaving the clinic I was ready to go, however I was advised that he could not fit me into the following days theatre list, however they had got me onto the morning list on Thursday. As I live in Hampshire they organised for me to return the following day and arranged overnight accommodation so that I could be admitted at 7.00am and I was first on the list. I was taken into theatre at 8.30am and thankfully there was no cuff erosion, however I had a stricture in my urethra which they sorted out for me straight away. I suppose what I am trying to say is that I have never been treated with the respect and concern that I have had from the team at the hospital. All the way through I was well informed and made to feel important. All the members of the nursing team and everyone I had contact with during this episode were sincere and could not do enough to make sure I was ok. I was dreading the whole scenario as I have had loads of bad experiences in the past at other hospitals. All the staff, and I mean ALL the staff from the receptionist to the canteen staff to the nursing team at University College Hospital London are amazing, they work as a team and treat you with kindness and concern. They are a shinning light in the midst of the chaos of the NHS and other hospitals could take a page from their book and learn a thing or two about patient care, kindness and compassion.

    Articles On Pancreatic Cancer

    Pancreatic Cancer

    Pancreatic Cancer – Pancreatic Cancer Diagnosis and Early Detection

    Pancreatic cancer may go undetected until it’s advanced. By the time symptoms occur, diagnosing pancreatic cancer is usually relatively straightforward. Unfortunately, a cure is rarely possible at that point.

    (This section focuses on pancreatic adenocarcinoma, which account for more than 95% of pancreatic cancer. Other forms of pancreatic cancer are mentioned at the end.)

    Diagnosing pancreatic cancer usually happens when someone comes to the doctor after experiencing weeks or months of symptoms. Pancreatic cancer symptoms frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin). A doctor then embarks on a search for the cause, using the tools of the trade:

    • By taking a medical history, a doctor learns the story of the illness, such as the time of onset, nature and location of pain, smoking history, and other medical problems.
    • During a physical exam, a doctor might feel a mass in the abdomen and notice swollen lymph nodes in the neck, jaundiced skin, or weight loss.
    • Lab tests may show evidence that bile flow is being blocked, or other abnormalities.

    Based on a person’s exam, lab tests, and description of symptoms, a doctor often orders an imaging test:

    • Computed tomography (CT scan): A scanner takes multiple X-ray pictures, and a computer reconstructs them into detailed images of the inside of the abdomen. A CT scan helps doctors make a pancreatic cancer diagnosis.
    • Magnetic resonance imaging (MRI): Using magnetic waves, a scanner creates detailed images of the abdomen, in particular the area around the pancreas, liver, and gallbladder.
    • Ultrasound: Harmless sound waves reflected off organs in the belly create images, potentially helping doctors make a pancreatic cancer diagnosis.
    • Positron emission tomography (PET scan): Radioactive glucose injected into the veins is absorbed by cancer cells. PET scans may help determine the degree of pancreatic cancer spread.

    If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy — taking actual tissue from the mass — can diagnose pancreatic cancer. Biopsies can be performed in several ways:

    • Percutaneous needle biopsy: Under imaging guidance, a radiologist inserts a needle into the mass, capturing some tissue. This procedure is also called a fine needle aspiration (FNA).
    • Endoscopic retrograde cholangiopancreatography (ERCP): A flexible tube with a camera and other tools on its end (endoscope) is put through the mouth to the small intestine, near the pancreas. ERCP can collect images from the area, as well as take a small biopsy with a brush.
    • Endoscopic ultrasound: Similar to ERCP, an endoscope is placed near the pancreas. An ultrasound probe on the endoscope locates the mass, and a needle on the endoscope plucks some tissue from the mass.
    • Laparoscopy is a surgical procedure that uses several small incisions. Using laparoscopy, a surgeon can collect tissue for biopsy, as well as see inside the abdomen to determine if pancreatic cancer has spread. However, laparoscopy has higher risks than other biopsy approaches.

    If pancreatic cancer seems very likely, and the tumor appears removable by surgery, doctors may recommend surgery without a biopsy.

    Continued

    Early Detection of Pancreatic Cancer

    Treating pancreatic cancer is challenging when it’s discovered at an advanced stage, as is usually the case. Researchers are seeking methods of early detection, but so far none has proved useful. These methods include:

    Blood tests. Certain substances, such as carcinoembryonic antigen (CEA) and CA 19-9, are elevated in people with pancreatic cancer. However, blood tests don’t allow for early detection of pancreatic cancer, because these levels may not rise until pancreatic cancer is advanced, if at all. These tests also may produce a false positive result.

    Endoscopic ultrasound. Some families have multiple members affected by pancreatic cancer. The American Cancer Society says that up to 10% of pancreatic cancers may be caused by inherited DNA changes. Studies are ongoing to see if aggressive screening with endoscopic ultrasound works for early detection of pancreatic cancer in healthy family members. Early results are promising. However, endoscopy is an invasive procedure, so its use is only justified in people already at high risk for pancreatic cancer.

    Pancreatic Neuroendocrine Cancers

    Pancreatic neuroendocrine tumors arise from a separate group of hormone-producing cells in the pancreas. Like adenocarcinoma, islet cell cancers are generally diagnosed with imaging and biopsy. These types of tumors may cause no symptoms or symptoms related to hormones secreted by the tumor.

    Sources

    American Cancer Society web site: “Detailed Guide: Pancreatic Cancer.”

    National Cancer Institute: “Islet Cell Tumors.”

    Osarugue A. Aideyan, Andrew J. Schmidt, Stephen W. Trenkner, Nadey S. Hakim, Rainer W.G. Gruessner , James W. Walsh

    Research output : Contribution to journal › Article

    Abstract

    PURPOSE: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction. MATERIALS AND METHODS: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available. RESULTS: Of the 63 biopsy specimens, 57 (90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%). CONCLUSION: CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.

    Original language English (US)
    Pages (from-to) 825-828
    Number of pages 4
    Journal Radiology
    Volume 201
    Issue number 3
    DOIs
    • https://doi.org/10.1148/radiology.201.3.8939238
    State Published – Dec 1996

    Keywords

    • Biopsies, complications
    • Computed tomography (CT)
    • Pancreas, CT
    • Pancreas, biopsy
    • Pancreas, interventional procedure
    • Pancreas, transplantation
    • guidance

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging

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    Fingerprint Dive into the research topics of ‘CT-guided percutaneous biopsy of pancreas transplants’. Together they form a unique fingerprint.

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    In: Radiology , Vol. 201, No. 3, 12.1996, p. 825-828.

    Research output : Contribution to journal › Article

    T1 – CT-guided percutaneous biopsy of pancreas transplants

    AU – Aideyan, Osarugue A.

    AU – Schmidt, Andrew J.

    AU – Trenkner, Stephen W.

    AU – Hakim, Nadey S.

    AU – Gruessner, Rainer W.G.

    AU – Walsh, James W.

    N2 – PURPOSE: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction. MATERIALS AND METHODS: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available. RESULTS: Of the 63 biopsy specimens, 57 (90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%). CONCLUSION: CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.

    AB – PURPOSE: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction. MATERIALS AND METHODS: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available. RESULTS: Of the 63 biopsy specimens, 57 (90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%). CONCLUSION: CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.

    Edward T. Casey, Thomas C. Smyrk, Lawrence J. Burgart, Mark D. Stegall , Timothy S. Larson

    Research output : Contribution to journal › Article

    Abstract

    Background. The most widely used grading scheme for acute pancreas allograft rejection grades biopsy specimens from 0 (normal) to V (severe rejection). Although the more advanced grades correlate strongly with immunologic graft loss, it is unclear how lesser grades impact graft outcome. The authors therefore report the outcomes of untreated grade II (minimal) rejection of solitary pancreas biopsy specimens. Methods. The authors retrospectively analyzed all solitary pancreas transplants performed at the Mayo Clinic between January 2001 and November 2002. The authors selected all patients who were found with grade II findings on biopsy. Whether patients underwent follow-up biopsies, what the results were, and graft survival at the end of the study period were then determined. Results. A total of 88 pancreas transplants were performed; 20 pancreas transplant recipients (23%) developed grade II (minimal) rejection and were followed for a mean of 22.8±8.7 months. Eighteen patients underwent biopsy for protocol purposes and two patients underwent clinically indicated biopsies. Of the patients who underwent biopsy as per protocol, 15 of the patients had a total of 25 follow-up biopsies: 10 were grade 0; 3 were grade I; and 10 were unchanged (grade II). Rejection in one patient progressed to grade III and in another patient to grade IV. The three patients who did not undergo repeat biopsy had a functioning allograft pancreas at the end of the study period. Of the two patients with grade II biopsy specimens obtained for clinical reasons, one had resolution of all inflammation noted on three follow-up biopsies, and the other patient did not undergo follow-up biopsy and died with a functioning graft. Conclusions. Grade II (minimal) rejection of solitary pancreas allograft rarely progresses to more severe degrees of inflammation. Morphologic findings in this category may not have unfavorable prognoses over a period of 2 years when untreated.

    Original language English (US)
    Pages (from-to) 1717-1722
    Number of pages 6
    Journal Transplantation
    Volume 79
    Issue number 12
    DOIs
    • https://doi.org/10.1097/01.TP.0000159148.13431.D0
    State Published – Jun 27 2005

    Keywords

    • Biopsy
    • Disease
    • Pancreas
    • Rejection
    • Transplantation

    ASJC Scopus subject areas

    • Transplantation

    Access to Document

    Fingerprint Dive into the research topics of ‘Outcome of untreated grade II rejection on solitary pancreas allograft biopsy specimens’. Together they form a unique fingerprint.

    Cite this

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    • BIBTEX
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    In: Transplantation , Vol. 79, No. 12, 27.06.2005, p. 1717-1722.

    Research output : Contribution to journal › Article

    T1 – Outcome of untreated grade II rejection on solitary pancreas allograft biopsy specimens

    AU – Casey, Edward T.

    AU – Smyrk, Thomas C.

    AU – Burgart, Lawrence J.

    AU – Stegall, Mark D.

    AU – Larson, Timothy S.

    N2 – Background. The most widely used grading scheme for acute pancreas allograft rejection grades biopsy specimens from 0 (normal) to V (severe rejection). Although the more advanced grades correlate strongly with immunologic graft loss, it is unclear how lesser grades impact graft outcome. The authors therefore report the outcomes of untreated grade II (minimal) rejection of solitary pancreas biopsy specimens. Methods. The authors retrospectively analyzed all solitary pancreas transplants performed at the Mayo Clinic between January 2001 and November 2002. The authors selected all patients who were found with grade II findings on biopsy. Whether patients underwent follow-up biopsies, what the results were, and graft survival at the end of the study period were then determined. Results. A total of 88 pancreas transplants were performed; 20 pancreas transplant recipients (23%) developed grade II (minimal) rejection and were followed for a mean of 22.8±8.7 months. Eighteen patients underwent biopsy for protocol purposes and two patients underwent clinically indicated biopsies. Of the patients who underwent biopsy as per protocol, 15 of the patients had a total of 25 follow-up biopsies: 10 were grade 0; 3 were grade I; and 10 were unchanged (grade II). Rejection in one patient progressed to grade III and in another patient to grade IV. The three patients who did not undergo repeat biopsy had a functioning allograft pancreas at the end of the study period. Of the two patients with grade II biopsy specimens obtained for clinical reasons, one had resolution of all inflammation noted on three follow-up biopsies, and the other patient did not undergo follow-up biopsy and died with a functioning graft. Conclusions. Grade II (minimal) rejection of solitary pancreas allograft rarely progresses to more severe degrees of inflammation. Morphologic findings in this category may not have unfavorable prognoses over a period of 2 years when untreated.

    AB – Background. The most widely used grading scheme for acute pancreas allograft rejection grades biopsy specimens from 0 (normal) to V (severe rejection). Although the more advanced grades correlate strongly with immunologic graft loss, it is unclear how lesser grades impact graft outcome. The authors therefore report the outcomes of untreated grade II (minimal) rejection of solitary pancreas biopsy specimens. Methods. The authors retrospectively analyzed all solitary pancreas transplants performed at the Mayo Clinic between January 2001 and November 2002. The authors selected all patients who were found with grade II findings on biopsy. Whether patients underwent follow-up biopsies, what the results were, and graft survival at the end of the study period were then determined. Results. A total of 88 pancreas transplants were performed; 20 pancreas transplant recipients (23%) developed grade II (minimal) rejection and were followed for a mean of 22.8±8.7 months. Eighteen patients underwent biopsy for protocol purposes and two patients underwent clinically indicated biopsies. Of the patients who underwent biopsy as per protocol, 15 of the patients had a total of 25 follow-up biopsies: 10 were grade 0; 3 were grade I; and 10 were unchanged (grade II). Rejection in one patient progressed to grade III and in another patient to grade IV. The three patients who did not undergo repeat biopsy had a functioning allograft pancreas at the end of the study period. Of the two patients with grade II biopsy specimens obtained for clinical reasons, one had resolution of all inflammation noted on three follow-up biopsies, and the other patient did not undergo follow-up biopsy and died with a functioning graft. Conclusions. Grade II (minimal) rejection of solitary pancreas allograft rarely progresses to more severe degrees of inflammation. Morphologic findings in this category may not have unfavorable prognoses over a period of 2 years when untreated.

    How to Undergo a Pancreas Biopsy

    Most common conditions

    Inflammation of the Pancreas / Pancreatic Cancer / Pancreatic Tumor

    Rated as serious conditon

    1 Veterinary Answers

    Most common conditions

    Inflammation of the Pancreas / Pancreatic Cancer / Pancreatic Tumor

    How to Undergo a Pancreas Biopsy

    Jump to section

    What is Pancreatic Biopsy?

    Your dog’s pancreas produces enzymes that digest food and insulin, which regulates the metabolism of carbohydrates. When disorder of the pancreas occurs, inflammation of the organ also occurs. Enzymes are released into the abdominal cavity where they react with your dog’s other organs and tissues, causing damage to these structures, and metabolism of carbohydrates is impaired. These conditions result in illness in your dog and the cause of pancreatic malfunction needs to be determined.

    Taking a sample of pancreatic tissue, a pancreatic biopsy, and sending this tissue for examination to locate disease (pathology) is the best way to isolate the cause of pancreatic disease or dysfunction. Biopsy of the pancreas can be performed by your veterinarian by open surgery (celiotomy), where an incision is made into the abdominal cavity to access the pancreas, or laparoscopically, by accessing the abdominal organ through a small incision with the aide of a camera to guide the procedure. Both procedures require anesthesia. Additionally, biopsy may be taken by fine needle aspiration through the abdominal wall. This may be done with sedation and local anesthetic if your dog is cooperative and, again, requires your veterinary practitioner to be equipped and skilled to perform this procedure.

    Pancreatic Biopsy Procedure in Dogs

    If biopsy by fine needle aspiration is being performed, sedation and local anesthetic may be adequate and a long needle will be inserted through your dog’s abdominal wall into the pancreas and fluid collected for assessment. This procedure will be guided by ultrasound.

    If surgical biopsy is being performed, your dog will require fasting, followed by general anesthesia.

    Pancreatic biopsy can be performed laparoscopically using a tube inserted through a small incision in your dog’s abdominal wall and into the abdominal cavity with a camera on the end to guide the procedure. Specialized surgical instruments will then be used to access the pancreas and guided by the information provided to your surgeon by the camera.

    Open surgery of your dog’s abdominal wall to access the pancreas and take a biopsy of the pancreas is more common in veterinary surgery. After your dog is under general anaesthetic the dog’s abdomen will be shaved and cleaned prior to making an incision in the abdominal wall. Tissues and organs will be moved aside carefully to access the pancreas. Care must be taken when locating a biopsy site to avoid blood supply and pancreatic ducts. Biopsies are often performed at the distal portion of the right limb of the pancreas, away from the center, to avoid these complications. Once isolated, a biopsy or tissue sample of the pancreas can be taken by several techniques including:

    Suture Fracture – non absorbing suture material is passed around an area of the pancreas and tightened to close off vascularization and ducts. The tissue on the outside is then removed and the incision closed.

    Blunt dissection and ligation – removes a wedge shaped tissue sample using a scalpel and the tying off blood vessels using traditional surgical methods.

    Once the biopsy is completed, incisions will be closed and observed for any signs of leakage prior to final closure of the abdominal cavity. The biopsy sample will be sent for analysis at a laboratory equipped to analyze pancreatic tissues and determine pathology present.

    Postoperatively, your dog may be observed for 24-48 hours and provided with intravenous fluids. Postoperative treatment will vary depending on the degree of illness and requirement for supportive care your dog requires.

    Efficacy of Pancreatic Biopsy in Dogs

    Pancreatic biopsy is recognized as the most effective way to determine the cause of pancreatitis and pancreas disorder. Because pancreatic disease can be located diffusely, multiple biopsies may be required to get an accurate diagnosis.

    Pancreatic Biopsy Recovery in Dogs

    Recovery from pancreatic biopsy, especially if performed by needle aspiration or laparoscopically is relatively straight forward, however, because your dog’s illness necessitating this procedure is usually severe, recovery may be complicated by your dog’s condition. Medication will be provided by your veterinarian as appropriate. You will need to prevent your dog from interfering with any abdominal wounds, the use of an Elizabethan collar will assist with this. Monitor your dog for signs of bleeding or infection and address with your veterinarian immediately.

    How to Undergo a Pancreas Biopsy

    Cost of Pancreatic Biopsy in Dogs

    The cost of a pancreatic biopsy will vary widely depending on the medical condition of your dog, the cost of living in your area and the method of biopsy required. A needle biopsy is less invasive but requires specialized equipment and training, while open abdominal surgery to affect a biopsy requires general anesthesia and postoperative care. Pancreatic biopsy can range in price from $500 to $2,000 depending on the degree of intervention and expertise required.

    Dog Pancreatic Biopsy Considerations

    Because dogs requiring pancreatic biopsy are usually extremely ill prior to the procedure, anesthesia and surgery can be extremely risk and prognosis is guarded. Pancreatic biopsy involves the risk of anesthesia use if required, hemorrhaging, infection, and adhesions (scarring). Pancreatitis may be aggravated by this procedure. Discuss your dog’s condition and prognosis prior to this procedure and investigate surgical options for acquiring pancreatic biopsy.

    Pancreatic Biopsy Prevention in Dogs

    Exposure to poor diet, medications, and toxins can cause pancreatitis in your dog. Ensuring that your dog does not accidentally ingest inappropriate substances or foods will reduce the incidence of pancreatitis. When symptoms of illness occur in your dog prompt medical attention from a veterinarian to address symptoms and illness at an early stage will reduce the need for invasive procedures later on as disease progresses.

    *Wag! may collect a share of sales or other compensation from the links on this page. Items are sold by the retailer, not Wag!.

    Prostate Cancer
    Treatment Guide™

    Prostate Cancer Treatment Overview

    The Prostate Cancer Biopsy Procedure

    The prostate biopsy is the taking of tissue samples from the prostate gland and examining them underneath a microscope for cell differentiation. Cancerous cells are shaped and arranged differently than healthy cells. The more differentiated cancerous cells are from healthy cells, the more aggressive the cancer. If the biopsy reveals no cancerous cells, either you do not have prostate cancer, or the prostate biopsy missed the tumor. If the doctor believes the biopsy missed a tumor based on other factors such as your family history, a particular irregularity in the digital rectal exam , or a rising PSA density, you will receive a follow-up biopsy in six months. Seventy-five percent of men have negative primary prostate biopsies.

    Before the Prostate Biopsy
    Before undergoing the biopsy, a patient may take antibiotics to reduce the risk of infection after the prostate biopsy. The patient also should stop anti-inflammatory drugs , such as aspirin or ibuprofen, that may increase the risk of bleeding after the biopsy. Finally, the doctor may also order an enema before the prostate biopsy to remove feces and gas that may complicate the transrectal biopsy.

    Types of Prostate Biopsies
    There are three types of prostate biopsies: the transrectal, the transurethral, and the transperineal. The transrectal prostate biopsy is guided by the transrectal ultrasound (TRUS) through the anus and into the rectum. The transurethral biopsy is performed with a lighted cystoscope up through the urethra so the doctor can look directly at the prostate gland. The transperineal biopsy collects the tissue through a small incision in the perineum .

    The transrectal and transperineal prostate biopsies both use spring-loaded needles to collect their samples as quickly, efficiently, and painlessly as possible. The biopsy gun can collect between 6 and 13 samples, depending on how many a doctor believed is necessary to diagnose you correctly.

    Transperineal Prostate Biopsy
    Patients opting to undergo the transperineal biopsy may also be put under general anesthesia if they wish to be unconscious during the biopsy. Men who opt to have the transperineal biopsy performed may experience some tenderness as well as blood in the semen for one to two months afterwards.

    Transrectal Prostate Biopsy
    In the transrectal biopsy, transrectal ultrasound guides the doctor and the biopsy gun to the proper place. Patients who opt for this prostate biopsy may experience a small amount of bleeding from the rectum as well as blood and urine in the semen afterwards.

    Transurethral Prostate Biopsy
    The transurethral biopsy inserts the cystoscope into the urethra. Local anesthesia is given to numb the area. The doctor looks directly at the prostate through the cytoscope and then inserts a cutting loop to extract tissue. The cutting loop works by turning and extracting a small amount of tissue with each turn.

    Side Effects of Prostate Biopsy
    Only minimal pain is associated with both procedures, though, doctors are more commonly using local anesthesia to numb the tested area. After having the prostate biopsy, men may experience blood in their urine and their semen for a few weeks or up to two months afterwards. Some soreness or minimal bleeding (after the transperineal biopsy) may also be experienced for a few days. Some doctors recommend having someone drive the patient home to avoid unpleasantness or soreness. Also, patients who opt for local anesthesia may be groggy for a short time after the prostate biopsy. Patients may return to normal activities as soon as they feel able.

    In all three procedures, the pathologist needs multiple samples from different areas of the prostate to make an accurate diagnosis. Remember, if a tumor is small enough, it can be missed during the prostate biopsy. A doctor will examine patient’s circumstances and determine whether he needs a follow-up biopsy. If the pathologist does find prostate cancer, the next step is to assign a Gleason score.

    Abstract. 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.

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    Keyword Analysis

    Keyword CPC PCC Volume Score Length of keyword
    endoscopy biopsy of pancreas 0.9 0.7 5976 58 28
    endoscopy 0.43 0.8 3119 54 9
    biopsy 0.18 0.1 4193 15 6
    of 0.35 0.7 8546 8 2
    pancreas 0.16 0.9 8268 28 8

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    endoscopy biopsy of pancreas 0.51 0.8 1426 55
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    pancreasfoundation.org

    In certain circumstances, larger biopsy samples of the pancreas may be required. EUS allows the physician to obtain “core biopsies” of the pancreas in a similar fashion to FNA. What are the advantages of an EUS, compared to a CT scan, MRI, or ERCP? There are many different tests which can be used to evaluate the pancreas.

    mayoclinic.org

    Endoscopic ultrasound (EUS) is a minimally invasive procedure to assess digestive (gastrointestinal) and lung diseases. A special endoscope uses high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract and chest, nearby organs such as the pancreas and liver, and lymph nodes.

    wikihow.com

    Another method used to biopsy the pancreas is through an EUS. The doctor will numb your throat or place you under anesthesia. Then, an endoscope, which is a thin tube, is placed down your throat. A small needle is used with the scope that will go through the wall of the stomach into the pancreas to take a sample.

    stanfordhealthcare.org

    The biopsy may be done as a separate procedure, during another test, or during surgery to remove the pancreas. A biopsy is usually done in one of three ways. Fine Needle Aspiration (FNA) biopsy The doctor uses a CT scan or endoscopic ultrasound (EUS) to locate the tumor. Then the doctor inserts a long, thin needle through your skin and into the .

    pancan.org

    Endoscopic ultrasound (EUS) is a procedure that uses sound waves to take pictures of the pancreas, bile duct and digestive tract. An endoscope is a thin, lighted tube. It enters the patient’s mouth and is guided down through the stomach and into the first part of the small intestine (duodenum).

    cancerresearchuk.org

    Biopsy. There are different ways of taking a sample of cells (biopsy) to check for pancreatic cancer. . It shows the liver, bile ducts, pancreas and gallbladder. Your doctor passes a tube called an endoscope down your throat to take x-rays of the pancreas and gallbladder. The endoscope has a small camera and light at the end.

    cancer.org

    Upper endoscopy can be used to take biopsy samples of the esophagus, stomach, or small intestine (to find out if an abnormal area is cancer, for example). This is done by passing long, thin instruments, such as small forceps (pincers), down through the middle of the endoscope to collect the samples.

    dovemed.com

    Pancreas Needle Biopsy is a minimally invasive procedure. During this procedure, a biopsy of the pancreas tissue is performed to evaluate pancreas abnormalities, such as a pancreas mass, a pancreas cyst, and for any other abnormalities that affects the pancreatic function.

    healthtalk.org

    Doctors sometimes do a biopsy of the pancreas, or a biopsy of another affected organ, using a long, thin needle, which goes through the patient’s abdomen. Ultrasound scans help to guide the needle towards the tumour.

    Abstract

    Purpose

    The practice of seeking a biopsy to confirm a metastatic relapse of a prior breast cancer is individualized. Tumor samples have well-recognized importance in clinical and translational research, but also an increasing role in routine care. We sought to determine the attitudes of patients and breast cancer clinicians about biopsy at breast cancer relapses.

    Methods

    Consenting breast cancer patients and clinicians completed questionnaires with scenarios of decreasing personal benefit and increasing discomfort or inconvenience associated with biopsy at relapse of a prior breast cancer. For each scenario, patients were asked whether they would, would not, or were unsure about agreeing to a biopsy. Clinicians provided information about their practice, research activities, and usual biopsy habits. They were asked to estimate how often patients would agree to a biopsy under each of the conditions presented to patient participants.

    Results

    The majority of patients expressed a willingness to undergo a biopsy procedure of modest inconvenience and discomfort to establish an uncertain diagnosis, guide treatment, to participate in a trial, or for research purposes only. About 50% of patients indicated that they would undergo an invasive biopsy procedure requiring IV sedation or general anesthetic for purely altruistic reasons. In spite of being a largely academic group, clinician respondents underestimated patient willingness to have a biopsy in all scenarios, particularly when there was no attached personal benefit.

    Conclusion

    Breast cancer patients were very willing to undergo biopsy at breast cancer relapse for their routine care, clinical trials, or for research only. Clinicians act as the intermediary between patients and tumor tissue repositories, and clinician perceptions and practices should shift to match the altruistic attitudes of breast cancer patients.

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    Patient selection for a biopsy is important: It is intended to confirm the radiologic diagnosis in patients with potential active, aggressive, or malignant bone tumors.

    • If the analysis of the patient’s clinical symptoms and radiographs has been appropriate, the clinician should correctly anticipate the diagnosis in most cases.
    • The biopsy is done to confirm the initial diagnostic impression and to permit accurate grading of the lesion.

    For many patients referred for consultation regarding a bone tumor, a biopsy is not necessary for diagnosis and may be contraindicated; it could even be detrimental to their care.

    • Most patients with incidental lesions and painless bony masses do not need a biopsy. As long as the patient has no symptoms caused by the lesion and the clinician is certain that the patient does not have an aggressive or malignant lesion, it is not necessary to confirm the exact histological diagnosis.
    • Bone biopsy often requires a cortical window or hole to be made in the bone, which may put the patient at risk for pathologic fracture through the biopsy site.
    • Unnecessary biopsy of the incidental lesion also carries a risk of infection, phlebitis, and associated peri-operative complications.

    There is one further risk of biopsy in incidental lesions: Patients with asymptomatic benign cartilage tumours are at risk for misdiagnosis if biopsied.

    • Differentiation of benign and low-grade malignant cartilage tumors can be difficult on histological assessment alone. The clinician and the patient may face a very difficult decision regarding further surgery if the incidental lesion is biopsied and diagnosed as low-grade chondrosarcoma on histological analysis.
    • The best way to differentiate benign and low-grade cartilage tumors is a careful analysis of history, physical, and serial plain Xrays.
    • Biopsy of an asymptomatic cartilage lesion causes post-operative changes in the Xray that complicates the comparison of serial radiographs, and the biopsy itself may cause symptoms in the operative site.
    • If the lesion is asymptomatic and shows no radiological evidence of growth or erosive changes, the prudent course is radiographic and clinical follow up rather than biopsy.

    Other Issues Related to Biopsy and Staging

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    Keyword Analysis

    Keyword CPC PCC Volume Score Length of keyword
    endoscopy biopsy of pancreas 0.54 0.6 2419 95 28
    endoscopy 1.88 0.6 1511 31 9
    biopsy 0.29 0.5 213 18 6
    of 0.8 0.2 2429 5 2
    pancreas 0.33 0.7 3962 39 8

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    endoscopy biopsy of pancreas 1.32 0.8 2185 3
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    Search Results related to endoscopy biopsy of pancreas on Search Engine

    pancreasfoundation.org

    In certain circumstances, larger biopsy samples of the pancreas may be required. EUS allows the physician to obtain “core biopsies” of the pancreas in a similar fashion to FNA. What are the advantages of an EUS, compared to a CT scan, MRI, or ERCP? There are many different tests which can be used to evaluate the pancreas.

    mayoclinic.org

    Endoscopic ultrasound (EUS) is a minimally invasive procedure to assess digestive (gastrointestinal) and lung diseases. A special endoscope uses high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract and chest, nearby organs such as the pancreas and liver, and lymph nodes.

    wikihow.com

    Another method used to biopsy the pancreas is through an EUS. The doctor will numb your throat or place you under anesthesia. Then, an endoscope, which is a thin tube, is placed down your throat. A small needle is used with the scope that will go through the wall of the stomach into the pancreas to take a sample.

    stanfordhealthcare.org

    The biopsy may be done as a separate procedure, during another test, or during surgery to remove the pancreas. A biopsy is usually done in one of three ways. Fine Needle Aspiration (FNA) biopsy The doctor uses a CT scan or endoscopic ultrasound (EUS) to locate the tumor. Then the doctor inserts a long, thin needle through your skin and into the .

    pancan.org

    Endoscopic ultrasound (EUS) is a procedure that uses sound waves to take pictures of the pancreas, bile duct and digestive tract. An endoscope is a thin, lighted tube. It enters the patient’s mouth and is guided down through the stomach and into the first part of the small intestine (duodenum).

    cancerresearchuk.org

    Biopsy. There are different ways of taking a sample of cells (biopsy) to check for pancreatic cancer. . It shows the liver, bile ducts, pancreas and gallbladder. Your doctor passes a tube called an endoscope down your throat to take x-rays of the pancreas and gallbladder. The endoscope has a small camera and light at the end.

    cancer.org

    Upper endoscopy can be used to take biopsy samples of the esophagus, stomach, or small intestine (to find out if an abnormal area is cancer, for example). This is done by passing long, thin instruments, such as small forceps (pincers), down through the middle of the endoscope to collect the samples.

    dovemed.com

    Pancreas Needle Biopsy is a minimally invasive procedure. During this procedure, a biopsy of the pancreas tissue is performed to evaluate pancreas abnormalities, such as a pancreas mass, a pancreas cyst, and for any other abnormalities that affects the pancreatic function.

    healthtalk.org

    Doctors sometimes do a biopsy of the pancreas, or a biopsy of another affected organ, using a long, thin needle, which goes through the patient’s abdomen. Ultrasound scans help to guide the needle towards the tumour.

    A study finds cancer patients who underwent a tumor biopsy had longer survival rates than those who did not; however, past studies suggest biopsies may not be entirely safe. Ed Uthman, Flickr

    Among the many “common cancer myths and misconceptions” listed on a webpage of the National Cancer Institute is this one: A needle biopsy might cause microscopic cells from a malignant tumor to break off and spread to other parts of your body. Sounds convincing, but is it true? Intending to address this fear, researchers conducting a study of pancreatic cancer patients found those patients who underwent a tumor biopsy had longer survival rates than those who did not.

    This also sounds convincing, yet it does not directly answer the question. Additionally, the researchers analyzed survival rates for what most people undoubtedly see as just a brief length of time. Below are some of the facts (and links), you must decide for yourself.

    For the current study, a team of Mayo Clinic researchers examined data gathered on a database following Medicare patients with non-metastatic pancreatic cancer who underwent surgery between the years 1998 and 2009. In particular, the researchers focused on 498 patients who had a biopsy (specifically, an endoscopic ultrasound-guided fine needle aspiration or EUS-FNA) and 1,536 patients who did not have this procedure. Crunching the numbers, the researchers discovered patients with multiple comorbidities — more than one illness — and more recent diagnosis were more likely to receive EUS-FNA. After controlling for various factors, including comorbidity and age, EUS-FNA was marginally associated with improved overall survival, “but did not affect cancer-specific survival.”

    Importantly, the follow-up time amounted to just 21 months — less than two full years.

    Conflicting Data?

    This is not to say biopsies do cause spread of cancer cells, but at least one 2004 study found a correlation between “fine-needle aspiration and an increase in the incidence of sentinel node metastases.” While the two studies cannot be directly compared — one involves pancreatic cancer, the other breast cancer — the methods and analysis involved in both are similar, yet the researchers reach conflicting conclusions.

    “Biopsies are incredibly valuable,” Dr. Michael Wallace, a gastroenterologist and senior investigator of the study, stated in a press release. Part of his argument in favor of biopsies is that surgery for pancreatic cancer is “a very big operation,” and “most people should want to make sure they have cancer before they undergo surgery.”

    He notes one study that demonstrates nine percent of patients who underwent surgery because of suspected pancreatic cancer actually had benign disease. Seems the only firm conclusion to draw from these scientific studies is the decision to undergo a biopsy should be weighed carefully.

    Source: Ngamruengphong S, Swanson KM, Shah ND, Wallace MB. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut. 2015.

    How to Undergo a Pancreas Biopsy

    A prostate biopsy is a standard diagnostic tool for identifying prostate cancer. However, the procedure can be painful and stressful and does not always reach an accurate diagnosis.

    Despite this, more than a million people have prostate biopsies in the United States each year. Of these, only 200,000 receive a diagnosis of prostate cancer.

    While they can be medically useful, a prostate biopsy can lead to needless worry and immediate treatment for prostate cancer when it is not necessary. Many people do not need active treatment for early signs of prostate cancer.

    Several reliable alternatives to a biopsy can help a person assess their risk for prostate cancer, decide on further screening, and test for prostate cancer without causing excess worry.

    In this article, we explain three of these alternatives and their benefits.

    How to Undergo a Pancreas Biopsy

    Share on Pinterest A doctor can advise on the most suitable method of checking for prostate cancer.

    People should discuss with their doctors whether a prostate biopsy is suitable or an alternative may be better. A biopsy may be the best option when:

    • Levels of prostate specific antigen (PSA) are high or significantly higher than the size of the prostate suggests.
    • Imaging of the prostate suggests an aggressive form of cancer may be present.
    • An individual has an increased risk of prostate cancer.

    Three of the possible alternatives to a prostate biopsy include the following:

    Prostate cancer enzyme tests

    Some tests check for enzymes that prostate cancer produces to see if cancer is present and gauge whether it may be aggressive or fast growing. These tests use either blood or urine samples to determine a person’s overall risk for prostate cancer.

    Doctors usually recommend these tests for males who have high PSA scores or whose doctors find abnormalities during a digital prostate exam.

    A newer blood test is the 4Kscore test, which measures a person’s risk of prostate cancer.

    This test does not completely replace the need for a biopsy, but it can help identify who should have one. As a result, it may help doctors reduce the number of people who have biopsies.

    The 4Kscore test is also effective for testing African American and Afro Caribbean men for prostate cancer.

    Enzyme tests cannot identify every case of prostate cancer, but neither do biopsies. Instead, blood and urine screenings can identify the most aggressive presentations of the disease.

    Some forms of prostate cancer are slow growing rather than aggressive. Slow growing prostate cancer is unlikely to be fatal.

    Watchful waiting

    In most cases, a doctor will recommend a prostate biopsy due to a high PSA score. However, other health issues can contribute to an elevated PSA score. A PSA score also tends to increase with age.

    Waiting and testing PSA levels again can be helpful. If a PSA score remains high but has not changed since the last test, a person may not have prostate cancer.

    MRI scan

    How to Undergo a Pancreas Biopsy

    Share on Pinterest An MRI scan is less invasive than a biopsy.

    An MRI scan uses a magnetic field and radiofrequency pulses to produce a clear image of the prostate.

    Similarly to biopsies, MRIs can sometimes produce an incorrect result. However, they are less invasive and still give an accurate guide to prostate cancer risk.

    Doctors use a variety of MRI techniques to look for prostate cancer, including:

    • Diffusion weighted imaging: This examines how the prostate absorbs water.
    • Contrast imaging: The doctor observes blood flow in and around the prostate with the help of a dye.
    • Spectroscopic imaging: This aims to distinguish prostate cancer from other causes of prostate enlargement, such as infection.

    Each technique has strengths, weaknesses, and a variable ability to detect a type of prostate cancer. The most effective MRI methods combine several of these imaging techniques.

    For most men, testing for prostate cancer includes a blood test for PSA. Higher-than-normal PSA scores may suggest a problem with the prostate.

    If a PSA test or a digital rectal exam of the prostate shows a possible irregularity, a doctor may recommend further testing, such as a biopsy.

    During the biopsy, a doctor uses an ultrasound machine to look at the prostate. They insert a small device into the rectum to perform the ultrasound.

    Using a small, hollow needle, the doctor removes a tissue sample from the prostate. They send this to a laboratory where a pathologist views the sample under a microscope to check for abnormal cell growth.

    The biopsy may involve collection of several samples of prostate tissue during the procedure.

    A prostate biopsy can also help a doctor decide the stage of any cancer that is present. Knowing whether cancer is advanced or aggressive can help a doctor determine the best treatment.

    It will also help them decide whether treatment is necessary. For many men with low stage or slow growing prostate cancer, watchful waiting may be the best course of action.

    A study finds cancer patients who underwent a tumor biopsy had longer survival rates than those who did not; however, past studies suggest biopsies may not be entirely safe. Ed Uthman, Flickr

    Among the many “common cancer myths and misconceptions” listed on a webpage of the National Cancer Institute is this one: A needle biopsy might cause microscopic cells from a malignant tumor to break off and spread to other parts of your body. Sounds convincing, but is it true? Intending to address this fear, researchers conducting a study of pancreatic cancer patients found those patients who underwent a tumor biopsy had longer survival rates than those who did not.

    This also sounds convincing, yet it does not directly answer the question. Additionally, the researchers analyzed survival rates for what most people undoubtedly see as just a brief length of time. Below are some of the facts (and links), you must decide for yourself.

    For the current study, a team of Mayo Clinic researchers examined data gathered on a database following Medicare patients with non-metastatic pancreatic cancer who underwent surgery between the years 1998 and 2009. In particular, the researchers focused on 498 patients who had a biopsy (specifically, an endoscopic ultrasound-guided fine needle aspiration or EUS-FNA) and 1,536 patients who did not have this procedure. Crunching the numbers, the researchers discovered patients with multiple comorbidities — more than one illness — and more recent diagnosis were more likely to receive EUS-FNA. After controlling for various factors, including comorbidity and age, EUS-FNA was marginally associated with improved overall survival, “but did not affect cancer-specific survival.”

    Importantly, the follow-up time amounted to just 21 months — less than two full years.

    Conflicting Data?

    This is not to say biopsies do cause spread of cancer cells, but at least one 2004 study found a correlation between “fine-needle aspiration and an increase in the incidence of sentinel node metastases.” While the two studies cannot be directly compared — one involves pancreatic cancer, the other breast cancer — the methods and analysis involved in both are similar, yet the researchers reach conflicting conclusions.

    “Biopsies are incredibly valuable,” Dr. Michael Wallace, a gastroenterologist and senior investigator of the study, stated in a press release. Part of his argument in favor of biopsies is that surgery for pancreatic cancer is “a very big operation,” and “most people should want to make sure they have cancer before they undergo surgery.”

    He notes one study that demonstrates nine percent of patients who underwent surgery because of suspected pancreatic cancer actually had benign disease. Seems the only firm conclusion to draw from these scientific studies is the decision to undergo a biopsy should be weighed carefully.

    Source: Ngamruengphong S, Swanson KM, Shah ND, Wallace MB. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut. 2015.

    Background. Urinary amylase (UA) remains the most common biochemical parameter to detect rejection in bladder-drained pancreas allografts. With the development of the cystoscopic transduodenal pancreas transplant biopsy technique, tissue samples of the pancreas graft are now frequently obtained. A definitive correlative analysis between UA activity and biopsy results has not been done in the three different pancreas transplant categories (simultaneous pancreas-kidney, pancreas transplant alone, and pancreas after kidney).

    Methods. We studied 66 pancreaticoduodenal biopsy specimens obtained for hypoamylasuria. Rejection was defined as a greater than 25% decrease from stable posttransplantation baseline on two consecutive measurements at least 12 hours apart. To perform biopsies we used our newly developed 14- and 16-gauge core-cut needles (50 cm long). Biopsy specimens were considered positive if either pancreatic or duodenal rejection was found. To assess the quality of UA activity we studied 13 biopsy specimens from patients with stable UA levels; these 13 specimens were negative for rejection.

    Results. Acute rejection was diagnosed in 36 biopsy specimens (55%). The mean decrease in UA levels was 67%±8% (range, 28% to 99%) for the positive biopsy results, and 57%±16% (range, 22% to 92%) for the negative biopsy results (p=0.147). Within 1 month, UA levels returned to baseline in 19% of our patients with positive biopsy results versus 97% with negative results; postbiopsy 1-year graft survival was 64% versus 97% (p≤0.05). In assessing the test quality of our biopsy specimens (including 13 obtained for reasons other than hypoamylasuria), we found a sensitivity of 100% (stable UA levels mean no rejection) and a specificity of 30%. The predictive value of a positive test was 53%; of a negative test it was 100%. By performing biopsies we avoided antirejection treatment in 47% of the patients studied. We found no biopsy-related complications.

    Conclusions. Stable UA levels reliably rule out rejection; a decrease is a marker for acute rejection but is unspecific. Performing biopsy is currently the only way to reliably diagnose rejection in solitary pancreas recipients (pancreas transplant alone and pancreas after kidney) and in simultaneous pancreas-kidney recipients with isolated hypoamylasuria. The procedure is safe and should always be attempted to avoid unnecessary rejection treatment.

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    Abstract

    PURPOSE: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction. MATERIALS AND METHODS: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available. RESULTS: Of the 63 biopsy specimens, 57(90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%). CONCLUSION: CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.

    Journal

    Radiology – Radiological Society of North America, Inc.

    What is it?

    Needle pancreas biopsy is a procedure to take a tiny sample (biopsy) of your pancreas tissue. Procedures called core biopsy or fine-needle aspiration are used. The tissue sample will be checked under a microscope for cancer or other problems. It may take a few days to get the results.

    Why is this test done?

    A pancreas biopsy may be done when an ultrasound, a CT scan, or an MRI shows a problem with the pancreas.

    How do you prepare for the test?

    How is the test done?

    • You will need to take off all or most of your clothes. You will be given a cloth or paper gown to use during the test.
    • You may be given a sedative through a vein (IV) in your arm. The sedative will help you relax and stay still.
    • The area where the needle will go in will be numbed.
    • Your doctor will use ultrasound or a CT scan to help guide the biopsy needle into your pancreas.
    • Your doctor will use the needle to take a small sample of tissue from your pancreas. Then he or she will remove the needle.
    • Pressure will be applied to stop the bleeding. A bandage will be put on the puncture site.

    How long does the test take?

    The test will take about 30 to 60 minutes.

    How can you care for yourself at home?

    • You will be watched for 1 or 2 hours after the biopsy while the sedative wears off. You will be checked for any signs of internal bleeding.
    • You can go home if you have no problems after the test.

    Activity

    • Rest when you feel tired.
    • Avoid exercises that use your belly muscles, aerobic exercises, and strenuous activities such as bicycle riding, jogging, weight lifting for 1 week or until your doctor says it is okay.
    • Ask your doctor when you can drive again.
    • You will probably need to take 1 or 2 days off from work. It depends on the type of work you do and how you feel.
    • You will probably be able to shower the same day as the test, if your doctor says it is okay. Pat the puncture site dry. Do not take a bath for at least 2 days after the test, or until your doctor tells you it is okay.

    Diet

    • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

    Medicines

    • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
    • If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
    • Be safe with medicines. Read and follow all instructions on the label.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. Be safe with medicines. Read and follow all instructions on the label.

    Care of the puncture site

    • Keep a bandage over the puncture site for the first 1 or 2 days.

    When should you call for help?

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You passed out (lost consciousness).
    • You have severe trouble breathing.

    Call your doctor now or seek immediate medical care if:

    • You have new or worse belly pain, swelling, or bloating.
    • Bright red blood has soaked through the bandage over the puncture site.
    • You are sick to your stomach or cannot keep fluids down.
    • You are dizzy or lightheaded, or you feel like you may faint.
    • You have signs of infection, such as:
      • Increased pain, swelling, warmth, or redness.
      • Red streaks leading from the puncture site.
      • Pus draining from the puncture site.
      • A fever.

    Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

    Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to keep a list of the medicines you take. Ask your doctor when you can expect to have your test results.

    Where can you learn more?

    Enter K885 in the search box to learn more about “Needle Biopsy of the Pancreas: About This Test”.

    Current as of: December 9, 2019

    Medical Review: Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Howard Schaff MD – Diagnostic Radiology