Preoperative detection of gastrointestinal neuroendocrine tumors using endoscopic ultrasonography

Abstract

Objective: almost 30% of gastroenteropancreatic neuroendocrine tumors (GEPET) escape preoperative identification using standard imaging techniques. The goal of this retrospective study is to present our cumulative experience in the assessment of GEPET by preoperative endoscopic ultrasonography (EUS), and to compare it with a literature review.Patients and methods: thirty-seven patients with suspected specific hormonal syndromes were sequentially examined with US, CT, MRI, angiography, OctreoScan, and radial and sectorial EUS. Sixteen were males (43%) and 21 were females (57%), with a mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27 had 19 endocrine tumors in the pancreas and 14 tumors in their gastrointestinal tract. No tumors were demonstrated in 10 patients, hence they were used as a control group. Of all 37 patients, 24 were operated on or had histological samples collected, with the presence of 26 GEPET (10 carcinoids) being confirmed in 22 patients.Results: EUS sensitivity and diagnostic accuracy were 81% and 78%. Specificity was 80%. All these values were similar to the mean values obtained from the literature review.Three pancreatic rumors smaller than or equal to 1 cm (insulinomas) were detected, which had escaped diagnosis with previous US, CT, and MRI studies.An echoendoscopic examination of the pancreas could not be completed in two cases (5%), a pancreas carcinoid and an already gastrectomized double pancreatic gastrinoma.Conclusion: EUS is a good preoperative technique for GEPET detection, and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or HCT has been posited for tumor diagnosis and localization before surgery.

The Impact of Preoperative Endoscopic Ultrasound on the Surgical Management of Pancreatic Neuroendocrine Tumours

“…The sensitivity and specificity of EUS was 78% and 80%, respectively. EUS detected three PNETs (all insulinomas) that were smaller than 1 cm in size, which were missed by ultrasound, CT and MRI (6). In most cases, adding EUS-FNA to a basic EUS examination enhances the sensitivity of EUS by providing a cytological diagnosis without the risk of significant complications or the need for exploratory surgery (25).…”

“…Despite various radiographic imaging techniques, such as transabdominal ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography and octreotide scintigraphy, up to 30% of PNETs can be missed during preoperative evaluation (6). Published data suggest the superiority of endoscopic ultrasound (EUS) in detecting and localizing PNETs, particularly those smaller than 2 cm in size, compared with ultrasound, CT, MRI and endoscopic retrograde cholangiopancreatography (7)(8)(9).…”

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

“…The identification of a pancreatic mass as a pNET remains challenging [5] but important as pNETs have a significantly better outcome as compared to other non-endocrine malignant tumours of the pancreas [6]. Pancreatic NETs typically present as solid neoplasms but can present as cystic tumours due to secondary degeneration (approximately 18% of pNETs) [7].…”

“…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].…”

Endoscopic mucosal resection of a mid-esophageal carcinoid with EUS guidance

“…Esophageal carcinoids typically arise from the mucosal lamina propria or the submucosa [1,2]. EUS has proven utility in staging and interventional planning (endoscopy or surgery) for gastrointestinal neuroendocrine tumors, and EMR has a solid track record in removal of superficial lesions of the gastrointestinal tract [3,4]. Conceivably, use of a ligation band at the lesion base would increase the ease and safety of EMR, and this has been utilized for Barrett's dysplasia and rectal carcinoid resections [5].…”