A Pancreas Biopsy with Imaging Guidance is a diagnostic test in which a specialist removes a very small tissue sample from the pancreas so it can be examined under a microscope by a pathologist. Because the pancreas sits deep in the abdomen near major blood vessels and other organs, the biopsy is typically performed with imaging guidance—most commonly ultrasound or a CT scan—to help the clinician target the exact area of concern (such as a mass, nodule, or abnormal-looking region) and to reduce the risk of complications.

The test does not “measure” a number like a blood test. Instead, it provides cell-level information about the pancreas. The tissue sample can be evaluated for:

• Cancer or precancerous changes (for example, pancreatic adenocarcinoma or neuroendocrine tumors)
• Inflammation consistent with pancreatitis (acute or chronic)
• Infection (less common, but possible in certain situations)
• Benign (non-cancerous) conditions such as scar tissue or cyst-related changes

What the results mean (in plain language): A result may show that the sampled area is benign (not cancer), malignant (cancer), or indeterminate (not enough information from the sample to be sure). Sometimes results also identify the type of tumor and may include additional testing on the sample (such as immunohistochemistry or molecular testing) that helps guide treatment decisions. Because a biopsy samples only a small area, your care team interprets the findings alongside imaging, symptoms (such as abdominal pain), and lab results.

Doctors usually order a pancreas biopsy with imaging guidance when imaging tests (like CT, MRI, or ultrasound) show an abnormality and the care team needs a definite diagnosis. This test is often considered when there is concern for pancreatic cancer or when symptoms and imaging suggest pancreatitis or another pancreatic disease but the cause is unclear.

Common reasons it may be recommended include:

• A pancreatic mass or lesion seen on imaging that needs to be identified as benign or malignant
• Unexplained abdominal pain, especially persistent upper abdominal pain that may radiate to the back
• Unexplained weight loss, loss of appetite, or fatigue with imaging findings suspicious for a pancreatic problem
• Jaundice (yellowing of the skin/eyes) or dark urine, which can occur if a pancreatic mass blocks the bile duct
• Recurrent or chronic pancreatitis when the underlying cause is uncertain or when a tumor needs to be ruled out
• Pancreatic cysts or complex cystic lesions when imaging features suggest higher risk and tissue confirmation would change management
• Staging or treatment planning—confirming the diagnosis can help determine the best next steps (surgery, chemotherapy, radiation, or monitoring)

Imaging guidance (ultrasound or CT scan) is used to increase accuracy by helping the clinician reach the target safely. Depending on the location of the abnormality and your medical situation, the sample may be obtained through the skin using a needle (percutaneous biopsy) or by other guided approaches chosen by the care team.

• Pancreatic cancer (including pancreatic adenocarcinoma)
• Pancreatic neuroendocrine tumors (NETs)
• Acute pancreatitis
• Chronic pancreatitis
• Autoimmune pancreatitis (IgG4-related disease)
• Pancreatic cystic lesions (e.g., mucinous cystic neoplasm, intraductal papillary mucinous neoplasm/IPMN)
• Pancreatic pseudocyst (often related to pancreatitis)
• Metastatic cancer to the pancreas (less common)
• Pancreatic infection/abscess (uncommon, usually in specific clinical settings)

• Confirming or ruling out pancreatic cancer to guide timely treatment decisions
• Clarifying the cause of abdominal pain when pancreatic disease is suspected
• Determining whether a pancreatic mass is benign or malignant to avoid unnecessary surgery or delays in care
• Evaluating and managing pancreatitis (including identifying autoimmune causes that may respond to steroids)
• Assessing pancreatic cyst risk and deciding between monitoring, drainage, or surgical removal
• Supporting personalized care planning (tumor typing and, when appropriate, additional tissue testing to help select therapies)