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J Gastrointestin Liver Dis. 2016 Sep;25(3):317-21. doi: 10.15403/jgld.2014.1121.253.ned.

Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series.

Author information

1
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy. r.manta@libero.it.
2
Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.
3
Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
4
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
5
Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
6
Endoscopy Unit, Niguarda Ca-Granda Hospital, Milan, Italy.
7
Gastroenterology Unit, Ospedali Riuniti Ancona, Italy.
8
Pathology Unit Spedali Civili, Brescia, Italy.
9
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.

Abstract

BACKGROUND AND AIMS:

Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed.

METHODS:

This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured.

RESULTS:

A total of 80 patients (mean age: 58 +/- 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 +/- 8.5 mm vs 19.8 +/- 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor </=10 mm, and in a further 3 (15%) cases with a tumor diameter </=20 mm. CT overlooked the pancreatic lesion more frequently in patients with functioning than non-functioning p-NETs (46.5% vs 24.3%; P = 0.002). EUS allowed a more precise pre-operative tumor measurement, with an overall incorrect dimension in only 9 (11.2%) patients. Of note, the EUS-guided FNA suspected the neuroendocrine nature of tumor in all cases.

CONCLUSIONS:

Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.

PMID:
27689195
DOI:
10.15403/jgld.2014.1121.253.ned
[Indexed for MEDLINE]
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