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. 2002 Jan;222(1):63-9.
doi: 10.1148/radiol.2221010437.

Masses in or around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach

Sanjay Gupta  1 , Kamran Ahrar, Frank A Morello Jr, Michael J Wallace, Marshall E Hicks
Affiliations

Masses in or around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach

Sanjay Gupta et al. Radiology. 2002 Jan.

Abstract

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.

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