The Sol Goldman Pancreatic Cancer Research Center

Biopsy


Cancer is just one of many processes that can produce a mass lesion in the pancreas. Some forms of inflammation of the pancreas produce masses (such as autoimmune pancreatitis) as do some benign (non-cancerous) tumors. A mass detected in the pancreas by imagining techniques therefore is not necessarily a cancer. The "gold standard" for diagnosing pancreatic cancer remains the biopsy (sampling of a small amount of tissue from the mass followed by examination of the tissue sampled using a microscope). Imagining is therefore usually followed up with a biopsy. Biopsy can take a number of forms including fine needle aspiration (FNA), tissue needle core biopsy, or by excisional biopsy at the time of surgery.

FNA samples can be obtained through the EUS endoscope, or in conjunction with a CAT or MRI imaging. It is a safe procedure that involves passing a thin needle directly through the skin or through the EUS endoscope and into the tumor. The diagnosis of a pancreatic cancer based on a FNA is highly accurate, approaching 99%. However, in some instances, because the amount of tissue obtained is so small, a definitive diagnosis cannot be made. In these cases the biopsy procedure may have to be repeated. Biopsies obtained at the time of surgery are usually larger, and more often produce a definitive diagnosis.

Biopsies can be used to both determine if a tumor is present and, if a tumor is present, to classify the type of tumor. Pathologists are doctors specially trained to interpret these biopsies. Pathologists look at tissue from a biopsy (a small sample of tissue) as well as tissue from a resection (portions of organs or entire organs removed during surgery). The tissue is examined under a microscope to determine whether or not it is cancer and what kind of cancer it is. Typically, patients will not meet the pathologist interpreting their tissue. Like radiologists, the findings of the pathologist will be given in a report available to the other physicians on your team.