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

Abstract

GS Sandha. The impact of preoperative endoscopic ultrasound on the surgical management of pancreatic neuroendocrine tumours. Can J Gastroenterol 2008;22(10):817-820.BACKGROUND: Endoscopic ultrasound (EUS) is accurate in diagnosing pancreatic neuroendocrine tumours (PNETs), but its impact on surgical management is unclear. OBJECTIVE: To determine whether preoperative EUS findings altered the decision for, and extent of, surgery in patients with PNETs. METHODS: A retrospective review of patients referred for EUS because of suspected PNETs was conducted. The diagnosis of PNETs was confirmed by EUS-guided fine needle aspiration cytology, where indicated, or by surgical histology. EUS findings were compared with computed tomography (CT) findings to determine whether there was an impact on the decision for surgical management. RESULTS: Fourteen patients (10 women), with a mean age of 44 years, underwent EUS for suspected PNETs. PNETs were seen with CT in 10 of 13 patients (77%) and with EUS in 14 of 14 patients (100%). One obese patient could not fit into the CT scanner. This patient had five PNETs on EUS. Three patients with a normal CT scan were determined to have one or two PNETs on EUS. Three patients with one or two PNETs on CT were found to have five to eight PNETs on EUS. EUS altered the decision for possible surgical management in five of 14 patients (36%), either by identifying a PNET or by finding multiple and multifocal PNETs that were not visualized on CT scans. CONCLUSION: EUS is useful in the preoperative assessment of PNETs by providing information that significantly influences the decision for surgical intervention or changes the extent of the planned surgery.Key Words: Biopsy; Endosonography; Neuroendocrine tumour; Outcome; Pancreas Les répercussions de l'endoscopie préopértoire sur la prise en charge chirurgicale des tumeurs neuroendocriniennes du pancréas HISTORIQUE : L'endoscopie est une méthode précise pour diagnostiquer les tumeurs neuroendocriniennes du pancréas (TNEP), mais on n'en connaît pas exactement les répercussions sur la prise en charge chirurgicale. OBJECTIF : Déterminer si les résultats des endoscopies préopératoires modifient la décision d'opérer les patients atteints de TNEP et l'importance de la chirurgie. MÉTHODOLOGIE : Les auteurs ont procédé à une analyse rétrospective des patients aiguillés en vue de subir une endoscopie à cause de TNEP pré-sumées. Le diagnostic de TNEP était confirmé au moyen d'une cytologie par aspiration à l'aiguille guidée par endoscopie, au besoin, ou d'une histologie chirurgicale. Les auteurs ont comparé les résultats de l'endoscopie à ceux de la tomodensitométrie pour déterminer si la première avait des répercussions sur la décision de prise en charge chirurgicale. RÉSULTATS : Quatorze patients (dix femmes) d'un âge moyen de 44 ans ont subi une endoscopie à cause de TNEP présumées. La tomodensitométrie a révélé des TNEP chez dix des 13 patients (77 %) et l'endoscopie, chez 14 des 14 patients (100 %). Un patient obèse ne pouvait pénétrer dans le tomodensi...

EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors

“…Since the introduction of the 64-detector CT, the detection rate has increased significantly to 89%. Recent studies 21,24 (Table 3) have reported similar improved CT detection rates for PNETs. Alsohaibani et al 24 reported a CT detection rate of 77% in their 2008 series.…”

“…A number of older studies have also reported the superiority of EUS over CT for detecting PNETs (Table 3). These studies are heterogeneous in design, many involved very small number of patients, 16,21,22,[24][25][26] some did not uniformly use surgical pathology as a criterion standard for PNET diagnosis, 17,21,24 and others combined PNETs and extrapancreatic tumors in their analysis. 16,27 Other studies that have reported CT and EUS detection rates were not designed to compare the two modalities.…”

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

“…In earlier works both sensitivity and precision were low, with a specificity of 100% (6); however, they gradually increased, and sensitivity reached about 90% (94% in the most extensive series in the literature) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) (Table II).…”

EUS-FNA for Pancreatic Neuroendocrine Tumors: A Tertiary Cancer Center Experience

“…In a large series, EUS correctly localized PNET in 93% of cases [30]. Others have reported detection of PNET by EUS to be in the range 82-100% [9,16,18,[31][32][33][34][35]. In a case-control study including 36 patients who underwent surgical exploration without undergoing an EUS, EUS was found to be highly accurate and cost-effective when used early in the preoperative location strategy.…”