Objective:
This study aims to explore the optimal imaging-guided percutaneous coaxial core needle biopsy (PCNB) approach for difficult-to-biopsy pancreatic lesions.
Materials and Methods:
This retrospective study involved 175 patients who underwent CT-guided (82 patients; mean age, 62.9 ± 12.2 years; 33 women; 49 men) or optimized ultrasound-guided PCNB (93 patients; mean age, 61.9 ± 11.67 years; 36 women; 57 men) for difficult-to-biopsy pancreatic lesions between February 2017 and February 2022. Propensity score matching (PSM) was used to control for confounding factors. The puncture biopsy durations, puncture path depths, biopsy success rates, complications, and satisfactory sampling rates for the two groups were compared. The final outcomes were the pathological findings after surgery or biopsy, the final clinical diagnosis, and treatment outcome. The sensitivity, specificity, PPV, NPV, satisfactory sampling rate, and accuracy of histopathological results for CT and optimized ultrasound-guided biopsy were determined and compared.
Results:
After PSM, total of 50 patients (mean age, 64.48 ± 8.79 years; 10 women; 40 men) underwent CT-guided PCNB, and 50 patients (mean age, 63.42 ± 9.50 years; 15 women; 35 men) underwent optimized ultrasound-guided PCNB. All patients underwent CT-guided or optimized ultrasound-guided PCNB, and the primary successful puncture biopsy rate was 100%. The puncture path depth and duration of CT-guided PCNB were significantly greater than those of the optimized ultrasound-guided PCNB (p < 0.05). No major complications were observed, and 40 patients (40%) had minor complications. The incidence of complications, such as postoperative bleeding and the degree of postoperative pain, were significantly lower for optimized ultrasound-guided PCNB than for CT-guided PCNB. There were no significant differences in the diagnostic accuracy and sensitivity and the satisfactory sampling rates for the two imaging-guided PCNBs (p > 0.05).
Conclusion:
Optimized ultrasound-guided and CT-guided PCNBs are safe and effective for difficult-to-biopsy pancreatic lesions. Optimized ultrasound-guided PCNB is more time-saving and has fewer complications than CT-guided biopsy. Therefore, it should be adopted in clinical practice.
