Pancreatic Biopsy

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A pathologist examines a biopsy under a microscope.

What Is a Biopsy?

A biopsy is the removal of a tissue sample from the body for examination. The only way to decide if an abnormal mass or tumor is cancer is to get and analyze a biopsy. The biopsy may also show the type of pancreatic cancer. But not all biopsies give an exact diagnosis.

What Are the Challenges of Getting a Pancreas Biopsy?

The pancreas’ location is the biggest challenge in getting a biopsy. The pancreas sits in the back of the abdomen, surrounded by the stomach, small intestine, liver and spleen. Since it is not close to the surface, it is hard for the doctor to get to the pancreas to take a sample.

Biopsies Without Surgery

In the past, the only way to get a tissue sample from the pancreas was during surgery. Now, most doctors biopsy the pancreas using nonsurgical procedures like endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP). But if the patient is already scheduled for surgery to remove the tumor, the doctor will likely get the tissue sample then.

Types of Nonsurgical Biopsies

The most common way to get pancreatic tumor samples is called fine-needle aspiration (FNA). During an FNA, a needle is inserted into the tumor to get cells from the tumor.

A core needle biopsy (CNB) uses a larger needle than an FNA, so it can get a larger sample.

While FNA is currently more common for diagnosis, patients who get molecular profiling may need a CNB to get enough tissue for testing. CNB is commonly used in clinical trials, as well. Contact PanCAN Patient Services to learn more about when a CNB should be considered.

FNAs and CNBs can happen during an endoscopic ultrasound (EUS). An EUS-guided FNA is the most exact biopsy method for the pancreas. When pancreatic cancer spreads to other organs, such as the liver, a biopsy may be performed on the metastatic (new) tumor. This is commonly done through the abdomen.

Other biopsy types, such as a brush biopsy or forceps biopsy, can be done during an endoscopic cholangiopancreatography (ERCP). In a brush biopsy, a small brush passes through the endoscope to rub off cells from the pancreas. ERCP brushings are not as accurate as other methods for diagnosing pancreatic cancer.

In a forceps biopsy, forceps (tongs) pass through the endoscope to get a small piece of the tumor.

What Are the Advantages of Getting a Biopsy Without Surgery?

  • Does not require general anesthesia
  • Recovery period is short
  • Patient usually goes home the same day
  • Serious side effects are rare

What Are the Disadvantages?

Sometimes, the needle or brush used in the biopsy procedure misses the target. This can lead to a noncancerous diagnosis even when cancer cells are present in the pancreas.

What Happens After the Biopsy?

A pathologist analyzes the tumor sample under a microscope to look for cancer cells. Even the most experienced pathologists can have trouble finding pancreatic cancer cells. Sometimes, even if the pathologist thinks the sample is cancerous, it may not be possible to rule out an unusual noncancerous growth, such as an intraductal papillary mucinous neoplasm (IPMN).

What Should I Do if My Biopsy Is Inconclusive?

If the pathology report is inconclusive or does not match earlier imaging test results or the patient’s symptoms, you may want a second opinion. A diagnosis of a rare tumor type, like a pancreatic neuroendocrine tumor, is also a good reason to get a second opinion.

Since treatment depends on the specific type of pancreatic cancer, you should have a confirmed diagnosis before starting treatment. And patients often need an exact diagnosis to join a clinical trial.

If the tumor can be removed by surgery, and other tests and symptoms suggest pancreatic cancer, the surgeon may decide to go on with surgery.

We’re Here to Help

For free, in-depth and personalized resources and information on the diagnosis and treatment of pancreatic cancer, contact PanCAN Patient Services.

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Information reviewed by PanCAN’s Scientific and Medical Advisory Board, who are experts in the field from such institutions as University of Pennsylvania, Memorial Sloan-Kettering Cancer Center, Virginia Mason Medical Center and more.

Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note any personal information you provide to PanCAN’s staff during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and education efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so. For more information on how we may use your information, you can find our privacy policy on our website at