Diagnostic efficacy of percutaneous computed tomography-guided needle biopsy of suspected malignant pancreatic lesions using a large needle: a retrospective cohort study from a single academic institution

Objective This study aims to assess the diagnostic yield, accuracy, and safety of percutaneous computed tomography-guided needle biopsy for suspected malignant pancreatic lesions diagnosed based on preoperative CT or MRI scans, conducted in a large patient cohort using large-bore needles. Additionally, it seeks to identify the factors that influence the initial diagnostic yield. Methods A retrospective analysis was conducted on consecutive patients with suspected malignant pancreatic lesions, as indicated by CT or MRI scans. These patients underwent percutaneous CT-guided large-needle biopsies at a tertiary medical center between January 2018 and January 2024. We retrospectively investigated the diagnostic performance of this procedure and the factors influencing its diagnostic yield. Results A total of 882 patients were enrolled, and a 100% technical success rate was achieved. The overall initial diagnostic yield was 94.4% (833/882).The positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 100% (773/773), 43.1% (47/109), and 92.3% (814/882), respectively. Sixty-four complications (7.3%) were detected. In the multivariate analysis of percutaneous CT-guided biopsy of pancreatic lesions, the utilization of core needle biopsy (CNB) was found to be associated with a higher initial diagnostic yield (OR = 3.21, 95% CI: 1.53–6.73, p = 0.002). Solid-cystic lesions (OR = 0.30, 95% CI: 0.15–0.61, p = 0.001) and greater lesion depth (OR = 0.98, 95% CI: 0.96–0.99, p = 0.002) were found to be associated with a lower initial diagnostic yield. Lesion size, site, and access route were not associated with the initial diagnostic yield (all p > 0.05). Conclusion Percutaneous CT-guided needle biopsy serves as a supplementary approach for obtaining diagnostic specimens from patients with suspected malignant pancreatic lesions who are ineligible for surgery, in cases where endoscopic ultrasound-guided needle biopsy is either unsuitable or not feasible. The use of core needle biopsy (CNB) was associated with higher initial diagnostic efficacy, while solid-cystic lesions and greater lesion depth were correlated with lower initial diagnostic efficacy.