Topic: Caution: Investigate FULLY before going through with needle biopsy

Dad had his second ERCP today. Had a great technician! She was very caring and treated my dad as if he were her own parent. Dad was also scheduled to have a needle biopsy done today in order to confirm the type of cancer cell, but thanks to the technician's advice, we did not allow that to happen.

As you already know, the surgeon at U of C has decided that my dad is not resectable and has chosen not to operate on his tumor. Obviously, we were discouraged. This week, he was able to present my dad's case to the tumor board, where it was also presented to the transplantation team. The transplantation team also declined to take on my dad's case. They did, however, indicate that Mayo in Rochester would be our best hope, due to their liver transplant protocol for treating CC.

The reason I am posting this is to share some information that I was not aware of prior to Dad's ERCP and endoscopic ultrasound: Apparently, if the technician had done a needle biopsy, it may preclude my dad from being a candidate for liver transplantation. The reason behind this is that when a needle is inserted to remove cells for a biopsy, some doctors at Mayo fear that some of the cells may be released inside different layers of tissue on its way out, thus possibly spreading the cancer cells and precluding my dad from being a transplant candidate at Mayo. Obviously, that is pure speculation, and I have not done further research on this yet, as we had a very long day at the hospital, but I just thought I'd post this on here to get your points of view.

Additionally, the surgeon, after presenting to the tumor board, would have recommended that the technician replace my dad's plastic stent with a metal one, again precluding him from candidacy.

I'm not saying that Dad definitely is or is not a candidate for transplantation, or that even if we go to Mayo for the second opinion that he will opt for the surgery, but the fact that either the needle biopsy or the metal stent could have ruined my dad's chances at even TRYING to see if surgery is possible... IT MAKES ME LIVID.

He is home now, we are monitoring his temp and making sure he gets plenty of rest to recover from the ERCP, but I wanted to post this as a warning to anybody out there who may be getting a needle biopsy to confirm cancer... I am just so grateful for the doctor who shared this information with me and my family so we could make an INFORMED decision before completely dashing our chances for surgery.

2 (edited by kathyb Wed, 06 Jul 2011 11:22:25)

Re: Caution: Investigate FULLY before going through with needle biopsy

rodsdaughter,

Are you talking about a needle biopsy done during and as part of an ERCP?  I'm pretty sure I had a needle biopsy done during my ERCP. This is how it was confirmed 2 years ago.  After this I went to Mayo Rochester for another opinion and did the protocol work up for a transplant but did not quality.  I don't think they would have had me me go through the other tests if my biospy would have automatically disqualified me at that time.  Maybe things have changed.

I found a discussion on this: http://www.cholangiocarcinoma.org/punbb … ?pid=39012

My understanding is that a biopsy from outside the skin into the liver to get the samples would normally automatically disqualify a person for a liver transplant because when they pulled the needle out cancer cells could have seeded.

Someone asked the question about an ERCP biopsy, but I'm not seeing an answer. 

Thanks,
Kathy

Re: Caution: Investigate FULLY before going through with needle biopsy

Yes, I am talking about a needle biopsy done during and as part of an ERCP. Yesterday, my dad was scheduled to have an ERCP, an EUS, as well as a needle biopsy. During a previous ERCP, they did brushings but the cytology was unable to confirm the presence of cancer 100%, so they wanted to do a needle biopsy because there is a much better chance of identifying the cancer cells.

Like I said, I am relatively uninformed about all this, but sure am glad the doctor performing the ERCP had this discussion with us prior to the procedure. Otherwise, I would have known nothing about it, and possibly would have ruined his chances at Mayo. The doctor did not say that Mayo DEFINITELY would not consider my dad as a transplant candidate, but she did want me to be aware that it may be an issue somewhere down the Mayo road.

Thanks for posting that prior discussion, as well, Kathy.