Comparison Between Preoperative Image Guided Biopsy and Open Biopsy in Clinically Labeled “Unresectable Carcinoma Pancreas”

Abstract

Although clinical findings along with modern laboratory investigations and imaging can help to diagnose pancreatic cancer and label them respectable or unrespectable, tissue diagnosis is essential to confirm the diagnosis and proper management. This retrospective review was done form July 2004 to June 2006 in BIRDEM hospital, Dhaka, Bangladesh, in patient with clinically labeled 'unresectable carcinoma pancreas' to evaluate the preoperative and postoperative biopsy pattern with their histopathological diagnosis. Forty (40) patients were clinically labeled as ‘unresectable carcinoma pancreas'. Preoperative image guided biopsy was taken in 25 patients. Methods of preoperative tissue diagnosis with their histopathology reports were noted. In forty (40) patients it was planned to take open biopsy along with other palliative surgical procedures. In 38 patients tumours found unresectable and biopsy were taken from the lesion, involved organ or lymph node. In 2 patients curative resection were done and whole specimens were sent for histopathology. Histopathology report of post surgical specimen was compared with preoperative histopathology report. Preoperative biopsies were done by ERCP in 12 patients. Ten (10) image (ultrasonography, computed tomography scan) assisted fine needle aspiration biopsy were taken from the pancreatic lesion. Preoperative imaging failed to detect any pancreatic mass in the rest 3 patients but showed suspected liver metastasis. Image (computed tomography scan) assisted 03 fine needle aspiration biopsies were taken from 3 hepatic metastasis. Histopathological report showed pancreatic duct cell carcinoma in 19 (76%) patients, 1(4%) patients had chronic pancreatitis. Biopsy report was not conclusive in 2 (8%) patients. All 3 biopsies from liver focus were metastatic pancreatic cancer (12%). Histopathology report of laparotomy samples revealed that 35 patients (87.5%) had pancreatic duct cell carcinoma. Out of the rest 5 patients 2 patients (5%) were chronic pancreatitis, non Hodgkin's lymphoma 01 patients (2.5%), tuberculosis 01patients (2.5%) and metastatic renal cell carcinoma 01 patient (2.5%). Open biopsy has a greater diagnostic accuracy than preoperative biopsy in diagnosing unrespectable pancreatic carcinoma and to exclude other pancreatic mass lesions labeled clinically as ‘unrespectable carcinoma pancreas'. Open biopsy is recommended in clinically labeled 'unrespectable carcinoma pancreas'.

JCMCTA 2012 ; 23 (2): 53-57