Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography

Abstract

Background: the detection and diagnosis of neuroendocrine tumors (NETs) is challenging. Endoscopic ultrasonography (EUS) has a significant role in the detection of NETs suspected from clinical manifestations or imaging techniques, as well as in their precise localization and cytological confirmation using EUS-Fineneedle aspiration-puncture (FNA).Objective: to assess the usefulness and precision of EUS-FNA in the differential diagnosis and confirmation of NETs, in a retrospective review of our experience.Patients and methods: in a total of 55 patients with suspected NETs who underwent radial or sectorial EUS, 42 tumors were detected in 40 cases. EUS-FNA using a 22G needle was performed for 16 cases with suspected functional (hormonal disorders: 6 cases) and non-functional NETs (10 cases). Ki 67 or immunocytochemistry (ICC) testing was performed for all.There was confirmation in 9 cases (5 female and 4 male) with a mean age of 51 years (range: 41-81 years).All tumors were located in the pancreas except for one in the mediastinum and one in the rectum, with a mean size of 19 mm (range: 10-40 mm).Results: there were no complications attributable to FNA. Sensitivity was 100% and both precision and PPV were 89%, as a false positive result suggested a diagnosis with NET during cytology that surgery finally revealed to be a pancreatic pseudopapillary solid tumor.Conclusions: EUS-FNA with a 22G needle for NETs has high sensitivity and PPV at cytological confirmation with few complications.

Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm

“…[23][24][25][26] In our study, 35 of 39 (90%) cases were diagnosed as PNEN. We also verified whether the EUS-FNA is useful for prediction of pathological grade per the WHO2010.…”

Diagnostic Performance of Endoscopic Ultrasound (EUS)/ Endoscopic Ultrasound – Fine Needle Aspiration (EUS-FNA) Cytology in Solid and Cystic Pancreatic Neuroendocrine Tumours

“…Pancreatic NETs can be classified as functional and non-functional based on the hormones they secrete. The clinical diagnosis of functional tumours is easier compared to their non-functional counterpart [8]. Clinically, pNETs can either be benign or malignant with the incidence of malignancy being higher in the non-functioning pNETs [8].…”

“…The clinical diagnosis of functional tumours is easier compared to their non-functional counterpart [8]. Clinically, pNETs can either be benign or malignant with the incidence of malignancy being higher in the non-functioning pNETs [8]. In patients with functioning symptomatic pNETs, EUS and EUS-FNA has a significant role in the detection, precise localisation [6,9,10] and cytological confirmation of pNETs [6,8,[11][12][13].…”

“…In patients with functioning symptomatic pNETs, EUS and EUS-FNA has a significant role in the detection, precise localisation [6,9,10] and cytological confirmation of pNETs [6,8,[11][12][13]. EUS can diagnose pNETs smaller than 1 cm [5] and can give a cytological diagnosis in up to 90% of cases [6,8].…”

Diagnostic protocol for pancreatic neuroendocrine tumors (PNETs)

“…as it provided a high yield (sensitivity around 90%, specificity at 98%) (5-10) only second to EUS-FNA (almost 100%) (10)(11)(12)(13)(14)(15).…”