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Ultrasonografi Kılavuzluğunda Pankreas İğne Biyopsileri

Year 2009, Volume: 42 Issue: 2, 50 - 56, 01.08.2009

Abstract

To share the efficacy and success rates of the needle biopsies of pancreatic masses performed with various needle types under ultrasonography guidance in our department forms the purpose of our study. One hundred ultrasonography guided needle biopsies with various needle types of 18-22 G in size were applied to the patients with pancreatic masses betvveen 1993 May and 2005April. Mean age of the patients was 55.5 ± 12.0 years and woman/man ratio was 0.46. The pathological diagnosis was obtained from 82 patients. Tumor localizations were pancreatic head for 73%, corpus for 13%, tail for 9%, corpus-tail for 5% of the patients. Biopsies performed with computed tomography guided were excluded from the series. Needles used for 82 pancreatic biopsies were West-Cott 20 G in 65 cases, Sonopsy 21 G in 8 cases, Trucut 18 G in 7 cases, and VVest-Cott 22 G in two cases. The rates of accuracy were found 74.0%, 63.0%, 71.4%, and 50%, respectively. The sensitivity, specificity, and accu-racy rates were 70%, 100%, and 72.0%, respectively. No significant difference in accuracy was observed betvveen needles, and pancreatic localizations (p> 0.05). İn addition, success rates of cystic and soiid lesions were not different statistically (p= 0.05). No majör complication was observed. Ultrasonography guided needle biopsy is a useful method for diagnosis and management of pancreatic masses. The relationship betvveen pancreas and the adjacent main vascular structures should be considered befo-re the biopsy. If it is thought to be a saf e procedure, ultrasonography guided biopsy or computed tomography guided biopsy, if needed, for obese patients with too much abdominal air can be performed. Endoscopic ultrasonography guided biopsy is nee-ded for the patients with small pancreatic masses or vvhose diagnoses are not provided with repeated biopsies.

References

  • Brandt KR, Charboneau JW, Stephens DH, Vlelch TJ, Goellner JR. CT- and US-guided biopsy of the pancreas. Radiology 1993;187:99-104.
  • Smith EH. Complications of percutaneous abdominal fine- needle biopsy. Radiology 1991 ;178:253-58.
  • Sandıkçıoğlu TG, Erkuş D, Tolgonay G, Bayol Ü. Pankreas kitlelerinin tanısında ince iğne aspirasyon biyopsisinin yeri. Tan isal ve Girişimsel Radyoloji 1997;3:217-9.
  • Ferrucci JT, VVİttenberg J, Mueller PR, et al. Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy. AJR 1980;134:323-30.
  • RozenblitA, Wahl SI. Percutaneous needle biopsy and drai- nage İn: Bakal CW, Silberzvveig JE, Cynamon J, Sprayregen S (eds). Vascular and Interventional Radiology. Principles and Practice. Thieme, 2002:114-5.
  • Caspers JM, Reading CC, McGahan JP, Charboneau JW. Ultrasound-guided biopsy and drainage of the abdomen and pelvis. İn: Rumack CM, Wilson SR, Charboneau, JW eds. Diagnostic Ultrasound. 2nd ed. Vol. 1. Missouri: Mosby, 1998:599-612.
  • Balen FG, Liftle A, Smith AC, et al. Biopsy of inoperable pancreatic tumors does not adversely influence patient sur- vival time. Radiology 1994;193:753-5.
  • Dickey JE, Haaga JR, Stellato TA, Schultz CL, Hau T. Evaluation of computed tomography guided percutaneous biopsy of the pancreas. Surg Gynecol Obstet 1986;63:497-503.
  • Evans WK, Ho C, McLoughlin MJ. Fatal necrotizing pan
  • creatitis follovving fine needle aspiration biopsy of the pan­ creas. Radiology 1987;141:61-2.
  • Charboneau JW, Reading CC, Welch TJ. CT and sonog- raphically guided needle biopsy: Current techniques and new innovations. AJR 1990;154:1-10.
  • Gazelle GS, Haaga JR. Guided percutaneous biopsy of intraabdominal lesions. AJR 1989;153:929-35.
  • Bret PM, Fond A, Casola G, et at. Abdominal lesions: A prospective study of clinical efficacy of percutaneous fine- needle biopsy. Radiology 1986;159:345-6.
  • İtan i KM, Taylor TV, Green LK. Needle biopsy for suspicious lesions of the head of the pancreas: Pitfalls and imptications for therapy. J Gastrointest Surg 1997;1:337-41. 55
  • Chang KJ, Albers CG, Erickson RA, Butler JA, VVuerker RB, Liri F. Endoscopic ultrasourıd-guided fine needle aspiration of pancreatic carcinoma. Am J Gastroenterol 1994;89:263-6.
  • Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine- needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997;45:387-93.
  • DelMaschio A, Vanzulli A, Sironi S, et al. Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assess- ment, US, CT, and CT-guided fine-needle biopsy. Radiology 1991;178:95-9.
  • Carlson SK, Johnson CD, BrandtKR, Batts KP, Salomao DR. Pancreatic cystic neoplasms: The role and sensitivity of need­ le aspiration and biopsy. Abdom Imaging 1998;23:387-93.
  • Arıbaş BK, Dingil G, Koşar S ve ark. Ultrasonografi eşliğinde ince iğne aspirasyon biyopsisinin intra-abdominal lezyonlar- da tanı değeri. Açta Oncologica Turcica 2005;38:18-25.
  • Lewandrowski K, Lee J, Southern J, Centeno B, Warshaw A. Cyst fluid analysis in the differential diagnosis of pan­ creatic cysts: A new approach to the preoperative assess- ment of pancreatic cystic lesions. AJR 1995; 164:815-9.

Ultrasonography Guided Pancreatic Needle Biopsies

Year 2009, Volume: 42 Issue: 2, 50 - 56, 01.08.2009

Abstract

Bu çalışmanın amacını pankreas kitlelerine ultrasonografi kılavuzluğunda kliniğimizde yapmış olduğumuz iğne biyopsilerinin etkinliğini ve çeşitli tipteki biyopsi iğnelerinin başarı oranlarını paylaşmak oluşturmaktadır. Mayıs 1993-Nisan 2005 tarihleri arasında, 18-22 G çaplı çeşitli tipteki iğneler ile 114 pankreas kitlesi olan hastaya, ultrasonografi eşliğinde iğne biyopsisi yapıldı. Olguların yaş ortalaması 55.5 ± 12.0 ve kadın/erkek oranı 0.46 idi. Bu olgulardan, patolojik tanı elde edilen 82 olgu değerlendirildi. Bu olguların %73 (61)'ü pankreas başı, %13 (10)'ü gövdesi, %9 (7)'u kuyruğu ve %5 (4)'i gövde-kuyruk yerleşimliydi. Bilgisayarlı tomografi eşliğinde biyopsi yapılan hastalar değerlendirmeye alınmamıştır. Pankreas kitlelerine yönelik yapılan 82 biyopsinin; 65'inde West-Cott 20 G, sekizinde Sonopsy 21 G, yedisinde Trucut 18 G ve ikisinde West-Cott 22 G iğne kullanıldı. Doğru tanıya götürme oranları sırasıyla, %74.0, %63.0, %71.4 ve %50 bulundu. Bütün biyopsilerde ise duyarlılık %70, özgüllük %100, doğruluk %72.0 olarak belirlendi. Hem iğneler arasında, hem de pankreastaki yerleşimine göre, doğruluk oranları açısından anlamlı bir fark saptanmadı (p> 0.05). Kistik-solid lezyonlar arasında da, başarı oranları açısından belirgin fark saptanmadı (p= 0.05). Hastalarda majör bir komplikasyon izlenmedi. Pankreas kitlelerinde tanı koyabilmek ve tedaviyi yönlendirmek amacı ile ultrasonografi kılavuzluğunda yapılan iğne biyopsileri, tanıya yardımcı bir yöntemdir. Pankreasın ana vasküler yapılara olan komşuluğu dikkate alınmalı, vasküler yapılara zarar verilmeyeceğinden emin olunursa öncelikle ultrasonografi, aşırı kilolu hastalarda ise bilgisayarlı tomografi kılavuzluğunda biyopsi yapılabilir. Tekrar biyopside de sonuç alınamayan olgularda ve küçük pankreas lezyonlarında ise endoskopik ultrasonografi kılavuzluğunda biyopsi yapılması gereklidir.

References

  • Brandt KR, Charboneau JW, Stephens DH, Vlelch TJ, Goellner JR. CT- and US-guided biopsy of the pancreas. Radiology 1993;187:99-104.
  • Smith EH. Complications of percutaneous abdominal fine- needle biopsy. Radiology 1991 ;178:253-58.
  • Sandıkçıoğlu TG, Erkuş D, Tolgonay G, Bayol Ü. Pankreas kitlelerinin tanısında ince iğne aspirasyon biyopsisinin yeri. Tan isal ve Girişimsel Radyoloji 1997;3:217-9.
  • Ferrucci JT, VVİttenberg J, Mueller PR, et al. Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy. AJR 1980;134:323-30.
  • RozenblitA, Wahl SI. Percutaneous needle biopsy and drai- nage İn: Bakal CW, Silberzvveig JE, Cynamon J, Sprayregen S (eds). Vascular and Interventional Radiology. Principles and Practice. Thieme, 2002:114-5.
  • Caspers JM, Reading CC, McGahan JP, Charboneau JW. Ultrasound-guided biopsy and drainage of the abdomen and pelvis. İn: Rumack CM, Wilson SR, Charboneau, JW eds. Diagnostic Ultrasound. 2nd ed. Vol. 1. Missouri: Mosby, 1998:599-612.
  • Balen FG, Liftle A, Smith AC, et al. Biopsy of inoperable pancreatic tumors does not adversely influence patient sur- vival time. Radiology 1994;193:753-5.
  • Dickey JE, Haaga JR, Stellato TA, Schultz CL, Hau T. Evaluation of computed tomography guided percutaneous biopsy of the pancreas. Surg Gynecol Obstet 1986;63:497-503.
  • Evans WK, Ho C, McLoughlin MJ. Fatal necrotizing pan
  • creatitis follovving fine needle aspiration biopsy of the pan­ creas. Radiology 1987;141:61-2.
  • Charboneau JW, Reading CC, Welch TJ. CT and sonog- raphically guided needle biopsy: Current techniques and new innovations. AJR 1990;154:1-10.
  • Gazelle GS, Haaga JR. Guided percutaneous biopsy of intraabdominal lesions. AJR 1989;153:929-35.
  • Bret PM, Fond A, Casola G, et at. Abdominal lesions: A prospective study of clinical efficacy of percutaneous fine- needle biopsy. Radiology 1986;159:345-6.
  • İtan i KM, Taylor TV, Green LK. Needle biopsy for suspicious lesions of the head of the pancreas: Pitfalls and imptications for therapy. J Gastrointest Surg 1997;1:337-41. 55
  • Chang KJ, Albers CG, Erickson RA, Butler JA, VVuerker RB, Liri F. Endoscopic ultrasourıd-guided fine needle aspiration of pancreatic carcinoma. Am J Gastroenterol 1994;89:263-6.
  • Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine- needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997;45:387-93.
  • DelMaschio A, Vanzulli A, Sironi S, et al. Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assess- ment, US, CT, and CT-guided fine-needle biopsy. Radiology 1991;178:95-9.
  • Carlson SK, Johnson CD, BrandtKR, Batts KP, Salomao DR. Pancreatic cystic neoplasms: The role and sensitivity of need­ le aspiration and biopsy. Abdom Imaging 1998;23:387-93.
  • Arıbaş BK, Dingil G, Koşar S ve ark. Ultrasonografi eşliğinde ince iğne aspirasyon biyopsisinin intra-abdominal lezyonlar- da tanı değeri. Açta Oncologica Turcica 2005;38:18-25.
  • Lewandrowski K, Lee J, Southern J, Centeno B, Warshaw A. Cyst fluid analysis in the differential diagnosis of pan­ creatic cysts: A new approach to the preoperative assess- ment of pancreatic cystic lesions. AJR 1995; 164:815-9.
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Bilgin Kadri Arıbaş This is me

Gürbüz Dingil This is me

Ümit Üngül This is me

Gürsel Şahin This is me

Dilek Nil Ünlü This is me

Kamil Doğan This is me

Sevim Özdemir This is me

Zekiye PEKOL Şimşek This is me

Aliye Ceylan Zaralı This is me

Rasime Pelin Demir This is me

Kemal Arda This is me

Publication Date August 1, 2009
Published in Issue Year 2009 Volume: 42 Issue: 2

Cite

APA Arıbaş, B. K. ., Dingil, G. ., Üngül, Ü. ., Şahin, G. ., et al. (2009). Ultrasonography Guided Pancreatic Needle Biopsies. Acta Oncologica Turcica, 42(2), 50-56.
AMA Arıbaş BK, Dingil G, Üngül Ü, Şahin G, Ünlü DN, Doğan K, Özdemir S, Şimşek ZP, Zaralı AC, Demir RP, Arda K. Ultrasonography Guided Pancreatic Needle Biopsies. Acta Oncologica Turcica. August 2009;42(2):50-56.
Chicago Arıbaş, Bilgin Kadri, Gürbüz Dingil, Ümit Üngül, Gürsel Şahin, Dilek Nil Ünlü, Kamil Doğan, Sevim Özdemir, Zekiye PEKOL Şimşek, Aliye Ceylan Zaralı, Rasime Pelin Demir, and Kemal Arda. “Ultrasonography Guided Pancreatic Needle Biopsies”. Acta Oncologica Turcica 42, no. 2 (August 2009): 50-56.
EndNote Arıbaş BK, Dingil G, Üngül Ü, Şahin G, Ünlü DN, Doğan K, Özdemir S, Şimşek ZP, Zaralı AC, Demir RP, Arda K (August 1, 2009) Ultrasonography Guided Pancreatic Needle Biopsies. Acta Oncologica Turcica 42 2 50–56.
IEEE B. K. . Arıbaş, “Ultrasonography Guided Pancreatic Needle Biopsies”, Acta Oncologica Turcica, vol. 42, no. 2, pp. 50–56, 2009.
ISNAD Arıbaş, Bilgin Kadri et al. “Ultrasonography Guided Pancreatic Needle Biopsies”. Acta Oncologica Turcica 42/2 (August 2009), 50-56.
JAMA Arıbaş BK, Dingil G, Üngül Ü, Şahin G, Ünlü DN, Doğan K, Özdemir S, Şimşek ZP, Zaralı AC, Demir RP, Arda K. Ultrasonography Guided Pancreatic Needle Biopsies. Acta Oncologica Turcica. 2009;42:50–56.
MLA Arıbaş, Bilgin Kadri et al. “Ultrasonography Guided Pancreatic Needle Biopsies”. Acta Oncologica Turcica, vol. 42, no. 2, 2009, pp. 50-56.
Vancouver Arıbaş BK, Dingil G, Üngül Ü, Şahin G, Ünlü DN, Doğan K, Özdemir S, Şimşek ZP, Zaralı AC, Demir RP, Arda K. Ultrasonography Guided Pancreatic Needle Biopsies. Acta Oncologica Turcica. 2009;42(2):50-6.