Imaging controlled diagnostic interventions of cystic pancreatic lesions: when and why we prefer US or CT guidance

The US and CT guided interventional procedures is a widely accepted method when we have to characterize and diagnose the cystic pancreatic lesions. The aim of this report is to present which conditions and reasons affect our decision when to prefer US or CT guidance for interventional diagnostic FNA and FNB of cystic pancreatic lesions. 153 biopsies and aspirations in 115 patients/85 male and 30 female/ were performed on cystic lesions of the pancreas for a period of five years under US or CT control. Lesions ranged in diameter from 15mm to 130mm.We utilized CT guidance in 87 (56,86%) cases and US guidance in 66 (43,14%) cases. Ultrasound equipment Siemens-Adara supplied with 3.5 and 7 MHz linear and convex transducers, CT machine GE Sytec 3000i, needles and aspiration system were used. First line CT guided invasive procedures were performed successfully in 87 cases with cystic pancreatic lesions. Twenty-one times we had to repeat the CT guided intervention for accurate penetration and obtaining proper tissue material. US guided invasive procedures were preferred in 66 of all cases. CT guidance was utilized in deep, small and ultrasonographic non visible cystic lesions of the pancreas. 65 pseudocysts, 22 cystic pancreatic neoplasms, 24 adeno-carcinomas, 3 mesothelial and 1 lymphoepithelial cyst were proven. Our opinion is that US guidance for biopsies or aspirations of cystic pancreatic lesions is easier, less time consuming and effective method. In selected cases aspirations and biopsies under CT guidance is a method of choice