title: Role of fine-needle aspiration in the surgical management of pancreatic neuroendocrine tumors: utility and limitations in light of the new World Health Organization classification.
abstract: BACKGROUND
  Pancreatic neuroendocrine tumors (Panc-NETs) are rare and tend to get overshadowed by their more prevalent and aggressive ductal adenocarcinoma counterparts. The biological behavior of PancNETs is unpredictable, and thus management is controversial. However, the new World Health Organization classification has significantly contributed to the prognostic stratification of these patients. Concurrently, there have been advances in surgical techniques for benign or low-grade pancreatic tumors. These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation.
  
  
  OBJECTIVE
  To report on the utility and limitations of fine-needle aspiration in the preoperative evaluation and management of PancNETs.
  
  
  METHODS
  This was a retrospective review of our institutional tumor database from 2002 to 2012. There were 25 cases of PancNETs that were localized and staged by medical imaging and diagnosed by fine-needle aspiration.
  
  
  RESULTS
  Fourteen patients underwent laparotomy, with some requiring only limited surgery; 4 had laparoscopic resections; 4 were serially observed without surgical intervention; and another 3 were inoperable. After a mean follow-up of 37 months, more than half of the patients had no evidence of disease, including most of those who underwent minimally invasive surgery.
  
  
  CONCLUSIONS
  Fine-needle aspiration is a useful diagnostic adjunct to medical imaging in the preoperative evaluation and management of PancNETs. However, there are limitations with regard to grading PancNETs using this technique.
authors: From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors: Terence N
authors: TN
authors: Moyana
authors: Wayne S
authors: WS
authors: Kendal
authors: Avijit
authors: A
authors: Chatterjee
authors: Derek J
authors: DJ
authors: Jonker
authors: Jean A
authors: JA
authors: Maroun
authors: Laval
authors: L
authors: Grimard
authors: Wael
authors: W
authors: Shabana
authors: Richard
authors: R
authors: Mimeault
authors: Shaheed W
authors: SW
authors: Hakim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D013156:Splenectomy; D014944:World Health Organization