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Masses in or around the Pancreatic Head: CT-guided Coaxial Fine-Needle Aspiration Biopsy with a Posterior Transcaval Approach¹

¹ From the Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 325, Houston, TX 77030. Received February 9, 2001; revision requested March 20; revision received June 6; accepted July 5. Address correspondence to S.G.

PURPOSE: To evaluate the safety and feasibility of computed tomographic (CT)-guided coaxial fine-needle aspiration biopsy (FNAB) of masses in or around the head of the pancreas with a posterior approach that transgresses the inferior vena cava (IVC).

MATERIALS AND METHODS: The authors retrospectively reviewed the records of 29 patients with lesions located within (n = 24) or around (n = 5) the pancreatic head who underwent CT-guided FNAB with the posterior transcaval route due to obstruction of the anterior approach by bowel, liver, and/or other structures. A coaxial needle technique was used, with an outer 18-gauge needle positioned posterior to the IVC and an inner 22-gauge needle traversing the IVC to obtain a biopsy of each lesion. All biopsy specimens were subjected to cytologic evaluation. Medical records of all patients were evaluated for complications.

RESULTS: All lesions were safely accessed with the posterior transcaval approach without major complications. The biopsies revealed a malignant process in 21 patients, benign pancreatic cysts in two patients, and pancreatitis in one patient. There were five false-negative biopsy results. Minor complications occurred in four patients (small retroperitoneal hematomas occurred in three and abdominal pain occurred in one).

CONCLUSION: CT-guided coaxial FNAB by means of a posterior transcaval approach is a safe method for obtaining samples from lesions in or around the pancreatic head.

Index terms: Biopsies, 771.1262 • Computed tomography (CT), guidance, 771.1211 • Pancreas, biopsy, 771.1262 • Pancreas, cysts, 771.312 • Pancreas, neoplasms, 771.312, 771.321, 771.33 • Pancreatitis, 771.291