To compare the diagnostic efficacy, safety, and clinical value between direct core needle biopsy and coaxial-assisted biopsy for pancreatic lesions under ultrasound guidance.

This retrospective study enrolled 134 consecutive patients who underwent ultrasound-guided percutaneous pancreatic core needle biopsy at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2024. The patients were stratified into two groups according to the biopsy approach used: direct biopsy group (n=45) and coaxial needle-assisted biopsy group (n=89). Given the potential for selection bias and imbalanced sample sizes, one-to-one propensity score matching (PSM) was employed to balance baseline characteristics between groups, with age, gender, lesion size, and lesion location serving as matching covariates. After PSM, 45 matched pairs (90 patients in total) were included in the final comparative analysis. Primary outcomes included technical success rate and pathological diagnostic accuracy. Secondary outcomes comprised the number of needle passes, procedure duration, and complication rates. Statistical comparisons were performed using the independent samples t-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables, as appropriate.

After matching, baseline characteristics were well-balanced between groups (all P＞0.05). Both groups achieved a 100% technical success rate. The diagnostic accuracy was 97.8% (44/45) in both groups, showing no significant difference (P＞0.05). The direct biopsy group demonstrated significantly shorter operation time [(15.3±3.2) min vs (22.8±4.0) min] and fewer needle passes [(1.38±0.65) vs (2.51±0.98)] compared with the coaxial-assisted biopsy group (t=9.512 and 6.437, respectively; both P＜0.001). Complication rates were 11.1% (5/45) in the direct biopsy group and 13.3% (6/45) in the coaxial-assisted group, showing no significant difference (P＞0.05). No severe complications occurred in either group. In the matched cohort, 76 cases (84.4%) were diagnosed with malignant tumors and 14 (15.6%) with benign lesions.

This study demonstrates that ultrasound-guided direct core needle biopsy is safe and effective for diagnosing pancreatic lesions, showing comparable diagnostic efficacy to coaxial-assisted biopsy while being simpler to perform and requiring less time. It may be considered as the preferred method for pancreatic lesion biopsy.