The role of preoperative biopsy in pancreatic cancer.

Background Cyto-histological diagnosis of pancreatic pathology in the management of suspected pancreatic malignancy is re-evaluated in the light of evolving trends in management and tissue sampling. Methods The literature on cyto-histological diagnosis of pancreatic pathology was reviewed over the period 1977-2003. Results and conclusion Endoluminal techniques of tissue sampling carry less risk of tumour seeding and are the sampling methods of choice for potentially resectable lesions if a tissue diagnosis will alter therapy. Endosonar-guided biopsy in expert hands appears to be the most reliable tissue sampling technique. Transcoelomic sampling methods should be reserved for those with unresectable disease. All methods of cyto-histological diagnosis have high specificity but have a low negative predictive value. Therefore, potentially resectable lesions that are highly suspicious for malignancy should be explored even if preoperative histology or cytology is negative. [ABSTRACT FROM AUTHOR]