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Fine-Needle Aspiration Biopsy of Solid Pancreatic Masses: Comparison of CT and Endoscopic Sonography Guidance

¹ Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
² Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

OBJECTIVE. Imaging-guided biopsies of solid pancreatic masses are performed with either CT or endoscopic sonography at our institution. We compared test characteristics of fine-needle aspiration biopsies guided using CT with those guided using endoscopic sonography and secondarily evaluated for an effect of mass size.

MATERIALS AND METHODS. Of 70 solid pancreatic masses, 43 (mean size, 4.4 cm; range, 1.5-10.3 cm) underwent fine-needle (20- to 22-gauge) aspiration biopsy with CT guidance and 27 (mean size, 2.3 cm; range, 1.0-5.0 cm) underwent fine-needle (22-gauge) aspiration biopsy with endoscopic sonography guidance. The diagnostic rate, sensitivity, and negative predictive value (NPV) for each technique were compared using Fisher's exact test before and after stratifying masses by size as small ( 3 cm) or large (> 3 cm).

RESULTS. The overall diagnostic rate, sensitivity, and NPV of fine-needle aspiration biopsies guided using CT (97.7%, 94.9%, and 60%, respectively) were not significantly different from those guided using endoscopic sonography (88.9%, 85%, and 57.1%, respectively). Among small masses, the diagnostic rate and sensitivity for biopsies guided using CT (100% and 100%, respectively) were not significantly different from those for biopsies guided using endoscopic sonography (90.9% and 93.8%, respectively). Among large masses, the diagnostic rate and sensitivity (96.6% and 92.3%, respectively) for biopsies guided using CT were not significantly different from those for biopsies guided using endoscopic sonography (83.3% and 50%, respectively).

CONCLUSION. When biopsying solid pancreatic masses with fine needles, procedures guided with CT and those guided with endoscopic sonography have similar test characteristics regardless of mass size.

Keywords: biopsy • CT • endoscopic sonography • fine-needle aspiration biopsy • imaging-guided biopsy • oncologic imaging • pancreas • pancreatic cancer

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