Biopsy of the pancreas

One of the invasive ways to study the state of the tissues of the patient’s body is a biopsy. A biopsy implies that a section of the affected tissue is surgically removed from the subject, after which it is subjected to a thorough histological and microscopic analysis. The procedure requires surgical intervention of varying degrees, and refers to complex diagnostic methods. However, there are situations when other, non-invasive and less dangerous research methods cannot provide the doctor with the complete information necessary for making a diagnosis and prescribing treatment. So, for example, a biopsy is the most accurate method for detecting cancerous lesions of the pancreas, although its value is not limited to this.

What is a biopsy of the pancreas, why is it prescribed

The biopsy procedure itself is a diagnostic procedure associated with a certain type of surgical intervention. Typically, this method of examination is not prescribed as a preventive or primary. If the patient has already undergone simpler diagnostic measures, for example, ultrasound or magnetic resonance imaging, and according to their results, neoplasms were found in him, a tissue biopsy is performed in order to establish which cell degeneration process is present in the body – benign or malignant .

During a biopsy of the pancreas, the physician gets direct access to the abdominal cavity or to the organ itself. From potentially “dangerous” places of the body – non-healing wounds, polyps, ulcers, tumors – the doctor, using special surgical instruments, takes small pieces of tissue. These particles, which will later go for research, are called a biopsy.

The main purpose of the procedure is to study tissue samples of the affected organ, identify a specific disease, establish or confirm a diagnosis in order to develop a treatment regimen, control ongoing therapeutic measures, and establish the need for surgical intervention. In addition, a biopsy allows the most in-depth study of the affected area, and further differentiation of tumor processes in cells.

The procedure for taking samples of pancreatic tissue is usually carried out using a medical scalpel, as well as a special needle or endoscope.

Types of pancreatic biopsy

Doctors carry out the procedure with various instruments and methods, sometimes directly during operations on the abdominal cavity.

So, they distinguish:

• core biopsy;
• fine needle aspiration or percutaneous;
• laparoscopic;
• intraoperative;
• endoscopic.

A core-needle biopsy of an organ makes it possible to obtain a relatively large sample of tissue for study once. The diameter of the needle used in this case is 1 millimeter.

A percutaneous biopsy is also called a fine needle aspiration biopsy. This type of procedure is carried out most often. In this case, the physician uses a medical instrument in the form of a special pistol, at the end of which there is a nozzle in the form of a knife. When you press the button, the blade cuts through the tissue. A long thin needle with a syringe can also be used. An obligatory element of a percutaneous biopsy is a CT scanner or an ultrasound scanner, with the help of which the process is monitored.

Laparoscopic examinations are necessary to obtain a sample of a specific part of an organ. In this case, the doctor, making only small incisions, gets the opportunity to examine the abdominal cavity for the presence of metastases. If the patient is diagnosed with acute pancreatitis, laparoscopic biopsy makes it possible to assess the extent of the inflammatory infiltrate.

Intraoperative biopsy is performed directly during the operation. The doctor, gaining access to the abdominal cavity as a result of surgical intervention, selects a biopsy for study.

As for the endoscopic type of diagnosis, in this case, the physician gets to the pancreas through the duodenum using an endoscope and a special needle in the form of a nozzle on the endoscope. Thus, it is possible to take tissue from the head of the gland for examination.

In what cases is a procedure prescribed when it is impossible to carry out

Like any other type of diagnosis, a biopsy has a certain list of indications. Naturally, it can be carried out only on the prescription of the attending physician, if there is an objective need for this. So, a biopsy of the pancreas is performed in cases where:

• the patient is suspected of having cancerous tumors of the organ;
• other diagnostic methods showed the presence of neoplasms in the tissues of the gland, the nature of which must be established;
• non-invasive examination methods do not provide complete information necessary for diagnosis and treatment;
• the patient is diagnosed with acute or chronic pancreatitis;
• there is a need to establish the severity of the patient’s lesion with cancerous tumors.

Similarly, the biopsy procedure also provides for the presence of contraindications to conduct. A biopsy of the gland is not performed if:

• the patient gives a written refusal to biopsy;
• the patient has violations of the properties of blood clotting;
• the subject is in a serious condition, for example, connected to life support devices;
• there are non-invasive diagnostic techniques that can provide similar information in the same volume as a biopsy.

For pregnant women, this type of surgical intervention is practically not prescribed, because of the potential danger to the unborn child. Children’s age in some cases can also be an obstacle to a pancreatic biopsy.

Rules for preparing for the survey

The main requirement on which the effectiveness of diagnostics depends is the need to carry it out strictly on an empty stomach. 24 hours before the start of the procedure, the patient is forbidden to drink alcohol, and 12 hours before the procedure, smoking is prohibited.

On the day before the biopsy, a light diet is recommended, without fatty, spicy and fried foods. In the evening, a light dinner is allowed, but no later than 8-10 hours before the biopsy. At the same time, you can not drink any liquid.

The research process itself, regardless of the method of its implementation, can be quite painful, about which the doctor warns the patient in advance. The biopsy is usually performed under local anesthesia or general anesthesia. In this case, the doctor in advance specifies the absence of an allergy to anesthetics in the patient, if necessary, directs him to allergy tests.

Women in the first trimester of pregnancy should definitely inform the doctor about their special situation.

How are the different types of procedures performed?

A biopsy is carried out only in a medical institution, always under the control of ultrasound or computed tomography. In some cases, the patient may be admitted to a hospital.

The surgeon, nurses and anesthesiologist are required to comply with all asepsis rules in the process of taking material for research.

Percutaneous biopsy is the safest and least traumatic for the subject. The doctor can use a thin long needle or a special gun. Given the pain of the process, the patient is often offered local anesthesia.

After the anesthesia has worked, under the control of an ultrasound machine or a CT scanner, the physician inserts a needle through the anterior abdominal wall into the tissues of the organ. As a result of pumping out air from the cavity of the needle, biological material enters it. The biopsy gun works in a similar way. If the affected area is less than 2 centimeters in size, or if the patient is to undergo surgery or laparoscopy of the abdominal cavity, fine-needle aspirate biopsy becomes impractical.

A core biopsy is performed in a similar way – an anesthetic is also injected into the patient, and the doctor, using a large diameter needle (1 millimeter), takes tissue for examination.

Laparoscopy is considered the most successful way to carry out biopsy examinations. In this case, minimal invasiveness and injury risk are combined with high information content of the results. In addition to the pancreas, during laparoscopy, the doctor can examine the entire abdominal cavity, assess the condition of the organs located there, identify metastases and foci of necrosis. The patient is put into a state of drug-induced sleep, after which carbon dioxide is injected into the abdominal cavity. The doctor makes two or more small punctures through which special instruments, such as a laparoscope or biopsy needles, enter the abdominal cavity.

Endoscopic biopsy, most often, is relevant for cases where small neoplasms lie in the deep layers of the tissues of the head of the organ. An endoscope is inserted through the mouth and esophagus into the stomach cavity. From the stomach, the device enters the duodenum, from where a special nozzle can capture cells from the head of the gland. Given the small coverage of this method, it is used quite rarely.

Intraoperative examination is carried out directly during abdominal operations on the abdominal cavity. The method is considered the most informative, but also the most dangerous and traumatic for the patient. All requirements for abdominal operations are put forward to him. The patient is under general anesthesia when the surgeon cuts through the wall of his abdominal cavity, thus gaining direct access to the organ. The intraoperative biopsy itself can be performed in several ways. So, a direct biopsy is possible only in the presence of large superficial tumors located in the region of the upper or lower edge of the gland. It is carried out through an incision, or using special needles and guns. The transduodenal method is performed through the duodenum, in a closed or open way, using needles and an endoscope. The procedure can also be carried out with a thin needle with a 10 milliliter syringe, which contains 3-4 milliliters of air. The tumor is punctured and material is taken from it.

Features of processing seized material

After the surgeon has taken the affected tissues, they must be sent to the laboratory for study. The tissues are transported in special sterile test tubes. Diagnostics, before proceeding to the study of the biomaterial, processes it and prepares it for research.

The selected tissues are treated with paraffin or frozen, after which they are cut into the thinnest sheets – slices, using a microtome knife. The resulting sections are placed on rectangular sterile slides and stained.

The material prepared in this way is studied under a light microscope. Using high-precision optics, the doctor can determine the nature of the pathology that affected the organ, its severity, and even the prognosis of its development.

If microscopic examination is not enough to make a diagnosis and determine a cancerous tumor, an immunohistological study of tissues is performed. To do this, the sections are exposed to various antitumor sera. The appearance in one of the preparations of yellowish granules, distinguishable with a microscope, indicates that the tumor has exactly the nature against which the serum is directed in a particular section.

Electron microscopy occurs with an increase in the cells of the organ up to 100 thousand times, and allows you to explore the state of the organelles of the cells of the pancreas.

Complications and rehabilitation after the procedure

The most dangerous in terms of possible consequences is intraoperative biopsy of the organ. After abdominal surgery, the patient is in the intensive care unit, where his condition is gradually brought back to normal. After some time, he is transferred to the surgical department. Within 5-25 days after the operation, the subject is in a hospital.

After the examination with a thin needle, the patient remains under medical supervision for several hours. If during this time he feels normal, he is allowed to go home, preferably under the supervision of one of his relatives.

The rehabilitation period after diagnosis should be without smoking and drinking alcohol. Immediately after the procedure, it is not recommended to drive or operate other complex mechanisms.

From 3 to 30 days (depending on the type of diagnosis made), the patient is prohibited from physical activity.

The occurrence of complications after surgery is the exception rather than the rule. If the procedure was performed poorly, bleeding, peritonitis, false cysts and fistulas may occur.

Biopsy of the pancreas is a complex invasive technique for studying the state of the organ. If the patient has tumor formations, and all other research methods do not make it possible to determine whether the formations are malignant or benign, it is tissue biopsy followed by histological and microscopic examination that can provide the attending physician with the necessary information. As a method of diagnosing oncological diseases of the pancreas, it is a biopsy that today gives the most accurate results in 85-95% of cases.