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