1Riadh Abid

1El Farabi Imaging Cente, Sfax, Tunisia

Background:

Recall and illustrate the indications and technique of performing the puncture of a pancreatic mass through a selection of clinical cases. Detail and illustrate the technique of performing a puncture of a pancreatic mass through a selection of clinical cases. Compare the results of our series with those of the literature.

Material(s) and Method(s):

We conducted a retrospective study of 110 patients examined for a pancreatic mass between January 2008 and December 2018.

The indication and feasibility of the biopsy was discussed between the interventional radiologist and the clinician.

To the 110 patients, 116 biopsy punctures were performed. 4 patients had 2 biopsies and one patient had 3 biopsies because of a discrepancy between the clinico-radiological data and the histopathological results of the first biopsies.

Prior to the examination, a correct hemostasis assessment was required, a peripheral venous route was placed and local anesthesia of the puncture site was performed.

The puncture was performed using an 18 G automatic type needle with a 17 G coaxial sheath.

Result(s):

Out of the 110 patients, we counted 47 women and 63 men. Ages were between 39 to 79 years with an average of 60 years.

A direct route was possible in 84 cases anterior in 78 cases and posterior in 6 cases, transgastric in 14 cases and transhepatic in 12 cases.

The histological diagnosis after the first biopsy was adenocarcinoma, metastasis, lymphoma  neuroendocrine tumor, cystic tumors , chronic pancreatitis nodule, false cyst, cystic lymphangioma and normal pancreatic tissue.

No major complications were noted. A single complication of average severity type of a peripancreatic hematoma. Minor complications such as small hematoma on the path of the puncture, vagal shock or tolerable abdominal pain.

Conclusion(s):

The diagnosis of pancreatic cancer often made at a stage where the tumours is unresectable. In these cases, histological evidence of malignancy is required to initiate palliative therapeutic uptake. The radio guided biopsy puncture of the pancreas is considered difficult because of the deep localization of the organ as well as its narrow vascular relationships. The results of our study confirm that the puncture-guided percutaneous biopsy of the pancreatic masses is a powerful mean for the histological diagnosis