Endoscopic ultrasound guided trucut biopsy of pancreatic cystic lesions

Cystic pancreatic tumors are often associated with a distinctive clinical presentation, diverse pathological features, and usually indolent biological behavior. Clinical, imaging, laboratory, and pathology findings may permit early tumor detection, distinction from pseudocysts, and determination of the tumor type. The relatively limited accuracy of any one modality requires that we consider the combined results when making management decisions. Limitations of current techniques, including endoscopic ultrasound guided fine needle aspiration and cyst fluid analysis, have prompted efforts to develop improved diagnostic modalities, including endoscopic ultrasound guided trucut biopsy (EUS TCB). Although many centers have reported their experience with EUS TCB, there are no reports of the diagnostic utility and safety of EUS TCB. Our preliminary experience suggests that EUS TCB can safely be utilized in patients with cystic pancreatic tumors to provide a sufficient tissue sample to allow adequate histologic examination and diagnosis. The results may assist patient counseling and optimize clinical care and prognostic determination. The purpose of this chapter is to describe the potential role and technique of EUS TCB in patients with a cystic pancreatic lesion.