A simple method of percutaneous fine needle aspiration biopsy of malignant lesions in and around the pancreas following radiological localization is described. Biopsy was performed in 28 patients. Twenty-three were eventually considered to have malignant disease and biopsy was positive in 19 of these (83%), including 16 of 18 patients with carcinoma of the pancreas (89%). One patient developed an exacerbation of pancreatitis following the procedure. Surgery became unnecessary in 5 of the 18 patients with positive biopsies. From these results and from a review of the literature on percutaneous fine needle aspiration biopsy, we believe that this is a simple, relatively painless, reasonably safe and reliable method of obtaining a preoperative diagnosis and advocate the procedure as desirable in all patients in whom malignant disease is suspected and can be localized radiologically. Cunccr 4 1 : 2 4 13-24 19, 19 78. ERCUTANEOUS FINE NEEDLE ASPIRATION P biopsy is being increasingly recognized as a safe and reliable method of obtaining a tissue diagnosis without operation in patients with malignant lesions in and around the pancreas. 12~22* 23,31.36,37 The major technical problem is localization of the lesion and this has been achieved by biopsy during angiography with test injections of contrast material into appropriate arteries under fluoroscopic control, s1,s7 during echography using a special biospy t r a n s d u ~e r , ~~, ~~ and with computed tomography to image the position of the biopsy needle. 22 These somewhat elaborate procedures may be delaying more widespread acceptance of a valuable diagnostic method.
We have found a simpler approach to be highly successful. The lesions may be localized by various radiological techniques; we have used mainly endoscopic retrograde cholangiopancreatography (ERCP) and angiography. From a study of these examinations the lesions are relocated for biopsy by fluoroscopy. No special equipment is required and the examination may be performed either immediately after the local-