ONTROVERSY CONTINUES to exist concerning the C diagnosis and treatment of pancreatic carcinoma.
Even today there is widespread disagreement as to the best method of establishing a definitive diagnosis. On the one hand, there are those who advocate pancreaticoduodenectomy on clinical grounds without tissue confirmation: on the other hand, there are surgeons who rarely, if ever, perform such an operation even when histologic confirmation has been established. For many years, surgical texts and teachers have cautioned against the use of open or wedge pancreatic biopsy because it was believed to be unreliable and was associated with a significant risk of bleeding, fistula, infection, and even death.
Core Needle Biopsy
It was with this background that Kirtland, in 1951, proposed "a safe method of pancreatic biopsies" that employed the intraoperative use of the Vim-Silverman needle. l5 He successfully obtained core needle biopsies during surgery from two patients, one with pancreatic carcinoma and one with pancreatitis. Since that time it has generally been believed that the core needle is safer than the wedge biopsy and offers the theoretical advantage of easier access to deeply seated lesions.
'Today the Tru-cut disposable needle has replaced the Vim-Silverman. Nevertheless, needle biopsy may be technically difficult to perform, particularly if the lesion is small and deep seated, and the 2 mm diameter core specimen may be difficult to interpret on frozen section. False-negatives arise from sampling errors,