Just a simple question: While doing pancreatic FNA or biopsy, do we really need to take care to not hit the pancreatic duct? It seems challenging to avoid it. Will it cause some severe complication if the duct is hit during either FNA or tructu biopsy?
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There are no reports ( that I have come across ) of any significant adverse effects with FNA of the pancreas in either the dog or cat. One study in the human literature reported needle tract seeding of tumors, fistula formation, and ascites with an incidence of 1.2% patients. Another human study reported acute pancreatitis and aspiration pneumonia but only after aspiration of cystic lesions. Recommendations from these studies was to avoid needle passage through the main pancreatic duct or branch ducts, stopping aspiration if blood became visible in the syringe, or if there was obvious hemorrhage evident.
I treat it like a vessel and take an angle usually caudocranial or craniocaudal with the approach into the parenchyma to be fairly parallel to the panc duct similar to what you do with mesenteric LNs that are sandwiching the mesenteric artery. Not sure if there is vagus innervation of the panc duct (that’s beyond my neurology pay grade) but for bile ducts in cats sticking them theoretically can cause vagus paralysis hence the spring loaded bx issue in cats not sure if that applies to the panc duct or not. That being said have hit it wiht a 22 and 25g needle before and nothing happened but I’m also a big believer its really tough to do damage with a 25g needle and i have drained purulent panc ducts before without issue with a 22g but i always go as small as possible for the clean small cellular sample hence usually 25g.
Thank you for the great input, especially this craniocaudal technique is amazing