Correlation between positive biopsy rates and contrast-enhanced ultrasound findings in patients with pancreatic cancer: a retrospective analysis of percutaneous ultrasound-guided fine-needle aspiration

Background: Percutaneous biopsy is a commonly used method for the early pathological diagnosis of pancreatic cancer. As an important imaging modality, contrast-enhanced ultrasound (CEUS) improves the characterization of pancreatic lesions by assessing microvascular perfusion, thereby enhancing diagnostic accuracy. Although prebiopsy CEUS has been shown to enhance biopsy accuracy and success rates, how its findings directly affect puncture success remains to be fully understood. The study aimed to identify the ultrasound and clinical factors affecting the effectiveness of percutaneous ultrasound-guided fine-needle aspiration (US-FNA) and evaluate how CEUS perfusion characteristics influence biopsy results to aid pancreatic cancer diagnosis and broaden patient options. Methods: Clinical and imaging data of 814 patients who underwent percutaneous puncture for a pancreatic lesion from January 2018 to December 2023 in Peking Union Medical College Hospital were retrospectively evaluated, and 306 patients were finally enrolled. The pathological results of the biopsy were categorized as negative, suspicious, or positive. Patients were classified into a rich group and a poor group based on the CEUS results. A comparison of the positive biopsy rates between the two groups was conducted. Results: The study enrolled 155 males and 151 females. Among them, 191 (62%) had positive biopsy results, 86 (28%) were classified as suspicious, and 29 (9.5%) had negative results. According to the CEUS result, 61% (186/306) of patients were classified into the poor group, and 39% (120/306) of patients were classified into the rich group. The proportion of patients exhibiting negative biopsy results (15.8%) in the rich group was significantly greater than that observed in the poor group (5.4%) (P=0.001). Multivariate analysis further confirmed the independent influence of CEUS features on biopsy yield [odds ratio (OR) 0.471; P