EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery

doi:10.1016/S0016-5107(04)01807-3

Gastrointestinal Endoscopy

Volume 60, Issue 3, September 2004, Pages 378-384

https://doi.org/10.1016/S0016-5107(04)01807-3 Get rights and content

Background

The use of EUS for precise preoperative evaluation of pancreatic neuroendocrine tumors is well established; up to 80% of insulinomas can be localized. However, the EUS appearance of pancreatic neuroendocrine tumors can be similar to that of benign peripancreatic lymph nodes. The aim of this study was to evaluate the role of EUS-guided FNA in this setting.

Methods

Thirty patients (18 women, 12 men) with 33 pancreatic/peripancreatic lesions confirmed by surgery underwent EUS-guided FNA between February 1997 and September 2002. Transabdominal US and CT were obtained in all patients before EUS. The diagnosis of pancreatic neuroendocrine tumor was established based on morphologic appearance and immunohistochemical staining of cytologic and surgical specimens.

Results

EUS detected 32 of the 33 (96.9%) lesions (mean diameter 20 mm, range 5-97 mm). There was one complication (abdominal pain). For the 30 patients, the following diagnoses were made: functioning pancreatic neuroendocrine tumor (16 patients), non-functioning pancreatic neuroendocrine tumor (7), peripancreatic lymph node (5), inflammatory intrapancreatic nodule (1), and peripancreatic splenosis (1). Sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-guided FNA were 82.6%, 85.7%, 95%, 60%, and 83.3%, respectively. There was one false-positive diagnosis by EUS-guided FNA and 4 false-negative diagnoses. In two of the latter cases, EUS-guided FNA was unsuccessful.

Conclusions

EUS-guided FNA is accurate and safe for the diagnosis of pancreatic neuroendocrine tumor and may have a role in determining management strategy.

Section snippets

Patients and methods

A retrospective search of medical records identified 30 patients (18 women, 12 men; mean age 53.2, range 14-87 years) who underwent pre-operative EUS-FNA for suspected PNTs between February 1997 and September 2002. All patients but three had symptoms attributed to the lesion. Transabdominal US and CT were obtained in all patients before EUS, and 21 underwent MRI before EUS; most had imaging findings suggestive of PNT. All patients underwent surgery, and the results of EUS-FNA were compared with

Results

Transcutaneous US identified lesions (mean diameter 3.26 cm) in 6 patients (20%). Dual-phase helical CT with intravenous contrast identified lesions in 18 patients (60%). In the 12 patients for whom CT was negative, mean lesion size was 1.0 cm. MRI depicted lesions in 6 of 21 patients (28.6%); mean lesion size was 2.75 cm. In 11 patients (36.6%), all imaging studies obtained before EUS were negative. Mean lesion size in these patients was 1.0 cm (Table 1).

At EUS, 28 patients had solitary

Discussion

The diagnosis of PNT is based on the clinical presentation and the results of laboratory tests. Because these tumors are usually small, they are difficult to identify with standard imaging techniques such as transcutaneous US (sensitivity 15%) and CT (sensitivity 64%).10., 11., 15. Only two studies found CT and angiography to be highly accurate, and the results in both were influenced by patient selection.24., 25.

Other imaging techniques are being used to identify PNTs, e.g., SRS, but success

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Endoscopic ultrasound (EUS) is widely used as a cost-effective method for detecting pancreatic neuroendocrine tumors (PNTs), but its diagnostic value is variable among published studies. This meta-analysis aimed to determine the diagnostic value of EUS for PNTs.
Three electronic databases, including PubMed, Embase, and the Cochrane Library, were searched for studies published up to July 2018. The summary sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curve were calculated to evaluate the diagnostic value of EUS using the random-effects model.
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Citation Excerpt :
When assessing tumor characteristics, there exists heterogeneity in the literature regarding the utility of fine needle aspiration (FNA). Some investigators have relied heavily on pathologic results of FNA biopsies to determine management strategies [24–26, 28]. Fujimori et al. [14] have shown that EUS-FNA can successfully determine tumor grade for lesions <2 cm, though concordance with grading from surgical specimens if poorer for lesions ≥2 cm.
/Objective. To determine the outcomes of a non-operative management approach for sporadic, small, non-functional pancreatic neuroendocrine tumours.
A retrospective chart review of patients with non-functional pancreatic neuroendocrine tumours initially managed non-operatively at a single institution was performed. Patients were identified through a search of radiologic reports, and individuals with ≥2 cross-sectional imaging studies performed >6 months apart from Jan. 1, 2000 to Dec. 31, 2013 were included. Data on tumour size, radiologic characteristics at diagnosis, interval radiologic growth, and surgical outcomes were recorded.
Over the thirteen-year study period, 95 patients met inclusion criteria and were followed radiologically for a median of 36 months (18–69 months). Median initial tumour size on first imaging was 14.0 mm (IQR 10–19 mm). Median overall tumour growth rate was 0.03 mm/month (IQR: 0.00–0.14 mm/month). There was no significant relationship between initial tumour size and growth rate for tumours ≤ 2 cm or for lesions between 2 and 4 cm. Thirteen (14%) patients initially managed non-operatively underwent resection during the follow-up period. Reasons for surgery included interval tumour growth, patient anxiety or preference, or diagnostic uncertainty. Median time to surgery was 14 months (IQR 8–19 months). No patients progressed beyond resectability or developed metastatic disease during the observation period.
For patients with sporadic, small, non-functional pancreatic neuroendocrine tumours, radiologic surveillance appears to be a safe initial approach to management.
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One hundred and forty-nine patients with pancreatic cystic lesions met inclusion criteria. Pathologic diagnoses included pseudocyst (n = 14), SCN (n = 26), mucinous cystic neoplasm (n = 40), low-/moderate-grade IPMN (n = 34), high-grade IPMN (n = 20), invasive IPMN (n = 10), and solid pseudopapillary neoplasm (n = 5). Vascular endothelial growth factor A was significantly elevated in SCN cyst fluid compared with all other diagnoses (p < 0.001). With a threshold of >5,000 pg/mL, VEGF-A alone has 100% sensitivity and 83.7% specificity to distinguish SCNs from other cystic lesions. With a threshold of ≤10 ng/mL, CEA alone identifies SCN with 95.5% sensitivity and 81.5% specificity. Sensitivity and specificity of the VEGF-A/CEA combination are 95.5% and 100%, respectively. The c-statistic increased from 0.98 to 0.99 in the receiver operating characteristic analysis when CEA was added to VEGF-A alone.
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Original articlesEUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Gastroenterology

Gastroenterol Clin North Am

Surg Clin North Am

Gastrointest Endosc

Clin Radiol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

Gastroenterology

Pancreatic endocrine tumors

Pancreatic islet cell tumors

Surgery

Endocrine tumors of the pancreas

MRI of pancreatic neuroendocrine tumours

Br J Radiol

Original articles
EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery