A CT-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels

Comparative analysis of different biopsy techniques for pancreatic lesions in diagnostic value, safety, and cost-effectiveness

Background

Pancreatic cancer is highly lethal and often diagnosed at an advanced stage, highlighting the need for early and accurate diagnosis. Although imaging plays a crucial role, definitive pathological confirmation requires biopsy. Percutaneous ultrasound-guided core needle biopsy (US-CNB), computed tomography-guided core needle biopsy (CT-CNB), and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are the three main biopsy techniques, each differing in diagnostic accuracy, safety, and cost-effectiveness. The aim of this study was to compare the diagnostic value, safety, and cost-effectiveness of these three biopsy techniques for suspiciously malignant pancreatic lesions.

Methods

We retrospectively evaluated patients with suspicious malignant pancreatic lesions who underwent US-CNB, CT-CNB, or EUS-FNA from January 2018 to January 2023. We compared technical success rates, sample adequacy, diagnostic accuracy, sensitivity, specificity, and complication rates of three groups. Additionally, we calculated the cost/effectiveness ratio (C/E) and incremental cost-effectiveness ratio (ICER) for each method.

Results

A total of 399 patients were enrolled (US-CNB, n=86; CT-CNB, n=55; EUS-FNA, n=258), achieving 100% technical success. Sample adequacy satisfaction rates were 97.70% for US-CNB, 90.90% for CT-CNB, and 74.03% for EUS-FNA, with EUS-FNA significantly lower compared to the other two methods (P<0.001). Diagnostic accuracy was significantly higher for US-CNB (97.70%) and CT-CNB (90.90%) compared to EUS-FNA (69.80%) (P<0.001). Complication rates were 15.12% for US-CNB, 16.36% for CT-CNB, and 10.47% for EUS-FNA, with no significant differences (P=0.319). Compared to EUS-FNA, ICER for US-CNB was -14,367.7 yuan and for CT-CNB was -8,279.22 yuan per correct diagnosis, both below the willingness-to-pay threshold.

Conclusions

US-CNB and CT-CNB demonstrate superior diagnostic accuracy and specimen adequacy compared to EUS-FNA for suspected malignant pancreatic lesions. There are no significant differences in postoperative complication rates among three biopsy methods. In terms of cost-effectiveness, US-CNB and CT-CNB have lower costs and higher effectiveness than EUS-FNA, indicating greater economic efficiency.

Design of a wasp-inspired biopsy needle capable of self-propulsion and friction-based tissue transport

Percutaneous pancreatic core biopsy is conclusive but challenging due to large-diameter needles, while smaller-diameter needles used in aspiration methods suffer from buckling and clogging. Inspired by the ovipositor of parasitic wasps, which resists buckling through self-propulsion and prevents clogging via friction-based transport, research has led to the integration of these functionalities into multi-segment needle designs or tissue transport system designs. This study aimed to combine these wasp-inspired functionalities into a single biopsy needle by changing the interconnection of the needle segments. The resulting biopsy needle features six parallel needle segments interconnected by a ring passing through slots along the length of the needle segments, enabling a wasp-inspired reciprocating motion. Actuation employs a cam and follower mechanism for controlled translation of the segments. The needle prototype, constructed from nitinol rods and stainless steel rings, measures 3 mm in outer diameter and 1 mm in inner diameter. Testing in gelatin phantoms demonstrated efficient gelatin core transport (up to 69.9% ± 9.1% transport efficiency) and self-propulsion (0.842 ± 0.042 slip ratio). Future iterations should aim to reduce the outer diameter while maintaining tissue yield. The design offers a promising new avenue for wasp-inspired medical tools, potentially enhancing early pancreatic cancer detection, thus reducing healthcare costs and patient complications.

Safety and efficacy of ultrasound-guided percutaneous coaxial core biopsy of pancreatic lesions: a retrospective study

BACKGROUND AND OBJECTIVE

Pancreatic cancer tumors are difficult to access for biopsy. The use of coaxial needles during ultrasound (US)-guided coarse needle biopsy (CNB) may help to improve specimen collection yields and avoid tissue damage. In this retrospective study, the safety, efficacy, and clinical benefits of US-guided percutaneous coaxial CNB of pancreatic masses were evaluated and compared to those of non-coaxial CNB.

METHODS

A total sample of 220 biopsies performed from August 2015 to August 2019 were analyzed, including 114 performed with a coaxial needle (17-gauge coaxial coarse needle combined with an 18-gauge coarse biopsy needle) and 106 performed with a non-coaxial needle (18-gauge coarse biopsy needle without a coaxial sheath). The coaxial CNB group was stratified by lesion location to further evaluate the applicability of coaxial core needles. The satisfactory specimen rate, diagnostic efficiency, operating time, and complication rate were compared statistically between groups and subgroups.

RESULTS

Compared to the non-coaxial CNB group, the coaxial CNB group had a greater satisfactory specimen rate (98.3% vs. 92.3%; p = 0.048), a lesser mean operating time (8.9 ± 3.27 min vs. 16.8 ± 5.77 min; p < 0.001), and a lower complication rate (2.6% vs. 9.6%, p =0 .04). A better diagnostic efficiency was obtained for coaxial CNBs in the head of pancreas (98.7%) than in the body or tail of the pancreas (90%, p = 0.047).

CONCLUSION

For pancreatic masses, coaxial CNB can yield a higher satisfactory sample rate, lower complication rate, and shorter operating time than non-coaxial biopsy. US-guided percutaneous coaxial CNB is a safe and efficient puncture technique for pancreatic lesion diagnosis.

Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for the Diagnosis of Pancreatic Tumors

Endoscopic, ultrasound-guided tissue acquisition (EUS-TA) with rapid on-site evaluation is recommended as a first choice in the diagnosis of pancreatic lesions. Since EUS facilities and rapid on-site evaluation are not widely available, even in medical centers, an alternative for precise diagnoses of pancreatic tumor is warranted. The percutaneous computed tomography-guided, core needle biopsy (CT-CNB) is a commonly applicable method for biopsies. Our institute has developed a fat-transversing approach for pancreatic biopsies which is able to approach most tumors in the pancreas without penetrating organs or vessels. Herein, we report a 15-year experiment of pancreatic tumor coaxial CT-CNB in 420 patients. The success rate of tissue yielding by the technique was 99.3%. The overall sensitivity, specificity, and accuracy were 93.2%, 100%, and 93.4%, respectively. The diagnostic accuracy could be increased to 96.4% in 2016–2018 (after the learning curve period). The overall complication rate was 8.6%. Neither life-threatening major complications, nor seeding through the biopsy tract, were observed. Our study supported the hypothesis that CT-CNB could be a complementary option for diagnostic tissue acquisition in patients with unresectable or metastatic pancreatic tumors when EUS-TA is either unsuitable or unavailable.

CT-guided procedures: an initial experience

Background and aims

Despite their usefulness, CT-guided procedures have a low profile in Romania. The current study has the purpose of describing a first experience in performing these procedures.

Methods

Tumors and fluid collections that were inaccessible for biopsy or drainage by ultrasound or endoscopic guidance were included. The procedures were performed using a 64-slice GE Optima CT660 CT scanner. The biopsies were carried out using the coaxial technique with an 18 G semiautomatic needle. The drainages were performed using 10 F pig-tail drains that were inserted using the Seldinger technique. Data regarding the size and location of the target lesion, puncture technique, success and complication rates were recorded.

Results

Between May 2017 and April 2018, 30 procedures were performed, of which 26 biopsies and 4 drainage insertions. Of the biopsies 3 were mediastinal, 8 pulmonary, 6 retroperitoneal, 4 pelvic, and 5 of the bone. The drainages were performed for pelvic lymphoceles. The average lesion size was 3.2 cm (0.7–9 cm), with a depth from the skin of 9.1 cm (0.6–15.2 cm). The average procedure duration was 58 minutes (31–93 minutes). A conclusive histopathological diagnosis was set after 92.3% of biopsies. Three procedures resulted in complications, two being minor (hemothorax, soft tissue hematoma) and one severe (tension pneumothorax requiring drainage).

Conclusions

CT guidance offers safe access to lesions that cannot be biopsied or drained under ultrasound or endoscopic guidance.

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions

OBJECTIVE

The rate of pancreatic lesions has increased in recent decades due to the widespread use of advanced imaging techniques. Nowadays, a significant proportion of cases are incidentally discovered in asymptomatic patients and cytology is an important tool for the diagnosis and multidisciplinary management of these cases.

STUDY DESIGN

In this study we retrospectively review the experience with pancreatic fine-needle aspiration cytology in the last 17 years at a single large tertiary hospital in Madrid, Spain.

RESULTS

Our results indicate that more than 60% of pancreatic malignant lesions are cytologically confirmed before surgery and 30% of the patients are asymptomatic. Despite this, we have noted that the total number of malignant lesions surgically resected in our hospital has basically remained unchanged over the years, because incidental diagnosis is not always synonymous with resectability and a substantial number of patients are already metastatic at the time of diagnosis. Our series also shows an increase in the number of neuroendocrine tumors, which now represent almost 20% of all cytological diagnoses at our hospital. The sensitivity in our series is 70% and the false negative rate remains 30%, despite sample quality control by experienced cytologists and standardized technical conditions. Fibrosis and necrosis are the 2 features of the primary tumor that significantly and negatively influence the accuracy of cytologic diagnosis.

CONCLUSION

We herein report our experience with cytologic diagnosis of pancreatic lesions in a single tertiary hospital. Our results confirm that cytology is a safe, reliable, and important tool for pancreatic lesion diagnosis and management.