How to Perform Pancreatic Mass Fine Needle Biopsy

The differential diagnosis for pancreatic masses is broad, ranging from benign to malignant lesions such as autoimmune pancreatitis and pancreatic adenocarcinoma. Many pancreatic masses seen on radiology imaging require biopsy, and endoscopic ultrasound (EUS) has emerged as the premier diagnostic modality for safely acquiring tissue. EUS-guided tissue sampling occurs via fine needle aspiration (FNA) or fine needle biopsy (FNB). Endosonographers must carefully review cross-sectional imaging to understand the patient's anatomy, location of the mass, presence of potential metastatic disease and to anticipate potential difficulties in finding and sampling the mass. Esophagogastroduodenoscopy precedes EUS to ensure there are no anatomical abnormalities that may interfere with advancing the echoendoscope or visualizing the pancreas and surrounding structures and not infrequently reveals unexpected findings. Pancreatic masses usually appear hypoechoic and may be homogeneous or heterogeneous with regular or irregular borders. FNA/FNB of lymphadenopathy and metastases to surrounding structures should be performed to confirm metastatic disease.