EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors.
BACKGROUND
The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging.


OBJECTIVE
The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs.


METHODS
Retrospective single-center cohort study.


METHODS
Johns Hopkins Hospital.


METHODS
Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded.


METHODS
Detection rates of CT and EUS were compared by using pathology as the reference standard.


RESULTS
In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ(2) for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%).


CONCLUSIONS
Retrospective nonrandomized design and referral bias.


CONCLUSIONS
The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.
Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21205, USA.
Mouen A
MA
Khashab
Elaine
E
Yong
Anne Marie
AM
Lennon
Eun Ji
EJ
Shin
Stuart
S
Amateau
Ralph H
RH
Hruban
Kelly
K
Olino
Samuel
S
Giday
Elliot K
EK
Fishman
Christopher L
CL
Wolfgang
Barish H
BH
Edil
Martin
M
Makary
Marcia Irene
MI
Canto
D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*