Localisation of neuroendocrine tumours of the upper gastrointestinal tract.

Abstract

In order to localise neuroendocrine tumours of the foregut type (that is, of the stomach, duodenum, and pancreas), 18 patients were studied prospectively by endoscopic ultrasonography, computed tomography, transabdominal ultrasonography, magnetic resonance imaging, and somatostatin receptor scintigraphy. These 18 patients had a total of 25 primary tumour lesions which were verified histologically in tissue obtained by surgery or by ultrasound or endoscopy guided biopsy.Tumours were found in the stomach (n=-), duodenum (n=6), pancreas (n=17), and liver (n=l). Endoscopic ultrasonography had the highest sensitivity for tumour detection, followed by somatostatin receptor scintigraphy, computed tomography, transabdominal ultrasonography, and magnetic resonance imaging (88%, 52%, 36%, 32%, and 24% respectively). Endoscopic ultrasonography was especially sensitive in tumours smaller than 2 cm in diameter (88% v somatostatin receptor scintigraphy 35%; computed tomography 12%; transabdominal ultrasonography 6%; and magnetic resonance imaging 0%). Of 17 tumours located in the pancreas, endoscopic ultrasonography showed a sensitivity of 94% (somatostatin receptor scintigraphy 47%; computed tomography 47%; transabdominal ultrasonography 41%; and magnetic resonance imaging 29%). Of eight extrapancreatic tumours, six were identified by endoscopic ultrasonography, five by somatostatin receptor scintigraphy, and only one by computed tomography, transabdominal ultrasonography, and magnetic resonance imaging. One neuroendocrine tumour that was not detected by endoscopic ultrasonography was correctly identified by somatostatin receptor scintigraphy. Endoscopic ultrasound allowed correct determination ofthe tumour size and tumour spread into parapancreatic structures, especially the large vessels (T stage), in all 14 patients operated upon. The lymph node stage (N stage) was correctly determined in 10 of these 14 patients. In summary, endoscopic ultrasonography and somatostatin receptor scintigraphy were the most sensitive imaging methods for the localisation of these tumours and should be used as early diagnostic procedures to accurately stage neuroendocrine tumours of the foregut type. (Gut 1994; 35: 471-475)

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas

“…(5,16,18,20,21,(23)(24)(25) This adds the potential confounding factors of varying operator experience and different imaging techniques from center to center, issues that are known to have a significant impact on image quality and, hence, test sensitivity. This study presents our experience with the use of EUS for localizing neuroendocrine tumors of the pancreas and currently is the largest published single center experience worldwide.…”

“…Even in the case of malignant disease, the prognosis for patients with neuroendocrine tumors is far better than their counterparts with pancreatic adenocarcinoma and a significant number of patients can expect cure with surgical resection (3,4). This feature, coupled with the fact that many of the tumors are very small, typically Ͻ2 cm, make preoperative localization both critical and highly challenging (5).…”

“…Preoperative localization studies using extracorporeal ultrasound, CT, and angiography fail to localize the primary tumor in 40 -60% of patient, and frequently miss small tumors (Ͻ2 cm) (5,6). Recently, arterial stimulation of the tumor with the appropriate secretagogue followed by selective portal venous sampling, has improved localization sen-sitivity and specificity.…”

The influence of Ki-67 proliferation index on Tc-99m-EDDA-HYNIC-TOC somatostatin receptor scintigraphy in patients with carcinoids

“…Furthermore, In-111-octreotide has become the gold standard in diagnosing NETs in various locations [21][22][23][24][25][26][27][28]. However, poor physical properties of In-111 have triggered intense efforts to synthesize somatostatin analogues which can be labeled with Tc-99m, for the purpose of achieving better image quality, smaller expositional radiation doses per patient, and ready availability [29,30].…”

Endoscopic ultrasound: an overview of its role in current clinical practice

“…In the localisation of pancreatic neuroendocrine tumours, which are often <1 cm, EUS is superior to CT, MRI and somatostatin receptor scintigraphy 33 (Fig. 10).…”