Role of operative biopsy methods for biliopancreatoduodenal tumors

Biopsy of biliopancreatoduodenal tumors for histological diagnosis validation is an obligatory condition for palliative cancer surgery or non-resecting surgery for chronic bulbous pancreatitis. In such cases, aspiration, direct and Tru-Cut biopsy is performed. The problem of intraoperative biopsy of the biliopancreatoduodenal zone organs is in false negative results and serious complications. The aim of the present paper is to show the possibilities of intraoperative biopsy methods for morphological validation of biliopancreatoduodenal zone tumors. Materials and Methods. The analysis of intraoperative biopsy was performed in 178 patients (in 2004-2014). All the patients had diseases of the biliopancreatoduodenal zone organs, complicated by biliary and duodenal obstruction. Results. In the aspiration biopsy group, in 23 cases (41.8 %) the study was not informative (total number of patients was 55). In other patients, the accuracy of the aspiration biopsy was 85.7 %. The accuracy of Tru-Cut biopsy (n=34) and direct biopsy (n=89) was 88.3 % and 71.1 %, respectively. The incidence of false negative results for aspiration biopsy, Tru-Cut biopsy and direct biopsy was 10.7 %; 11.8 % and 18.1 % respectively. With direct biopsy of metastases and tumor tissue, positive results were obtained in all 37 cases. Without these cases, the number of false negative results after direct biopsy (32.6 %) was significantly higher than after aspiration biopsy (p=0.03) and trucut biopsy (p=0.03). After aspiration and open biopsy no complications were observed. Four (11.8 %) patients developed complications after trucut biopsy. Conclusion. False negative results are possible in all abovementioned methods of intraoperative biopsy. If technically feasible, the preference should be given to trucut biopsy. Open biopsy is better to use in cases of evident malignant dissemination and distant metastasis.