title: Potential value of EUS in pancreatic surveillance of VHL patients.
abstract: BACKGROUND
  Patients with von Hippel-Lindau (VHL) disease are prone to develop pancreatic neuroendocrine tumors (pNETs). However, the best imaging technique for early detection of pNETs in VHL is currently unknown. In a head-to-head comparison, we evaluated endoscopic ultrasound (EUS) and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET) compared with conventional screening techniques for early detection of pancreatic solid lesions in VHL patients.
  
  
  METHODS
  We conducted a cross-sectional, prospective study in 22 patients at a tertiary care university medical center. Patients with VHL mutation or with one VHL manifestation and a mutation carrier as first-degree family member, with recent screening by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS), were eligible. Patients underwent EUS by linear Pentax echoendoscope and Hitachi EUB-525, and (11)C-5-HTP PET. Patient-based and lesion-based positivity for pancreatic solid lesions were calculated for all imaging techniques with a composite reference standard.
  
  
  RESULTS
  In 10 of the 22 patients, 20 pancreatic solid lesions were detected: 17 with EUS (P < 0.05 vs CT/MRI+ SRS), 3 with (11)C-5-HTP PET, 3 with SRS, 9 with CT/MRI, and 9 with CT/MRI + SRS. EUS evaluations showed solid lesions with a median size of 9.7 mm (range 2.9-55 mm) and most of them were homogeneous, hypoechoic, isoelastic, and hypervascular. Moreover, EUS detected multiple pancreatic cysts in 18 patients with a median of 4 cysts (range 1-30).
  
  
  CONCLUSIONS
  EUS is superior to CT/MRI + SRS for detecting pancreatic solid lesions in VHL disease.(11)C-5-HTP PET has no value as a screening method in this setting. EUS performs well in early detection of pNETs, but its role in VHL surveillance is unclear.
authors.affiliation: Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: van Asselt
authors.affiliation: Department of Nuclear Medicine and Molecular ImagingUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Adrienne H
authors.initials: AH
authors.lastname: Brouwers
authors.affiliation: Department of GastroenterologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: van Dullemen
authors.affiliation: Department of RadiologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: van der Jagt
authors.affiliation: Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Nuclear Medicine and Molecular ImagingUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Alfons H
authors.initials: AH
authors.lastname: Bongaerts
authors.affiliation: Department of Nuclear Medicine and Molecular ImagingMartini Hospital Groningen, Groningen, The Netherlands.
authors.forename: Klaas P
authors.initials: KP
authors.lastname: Koopmans
authors.affiliation: Department of Laboratory MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Ido P
authors.initials: IP
authors.lastname: Kema
authors.affiliation: Department of Internal MedicineUniversity Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Zonnenberg
authors.affiliation: Department of MedicineDivisioin of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Henri J
authors.initials: HJ
authors.lastname: Timmers
authors.affiliation: Department of EndocrinologyErasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Wouter W
authors.initials: WW
authors.lastname: de Herder
authors.affiliation: Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Sluiter
authors.affiliation: Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Elisabeth G
authors.initials: EG
authors.lastname: de Vries
authors.affiliation: Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands t.p.links@umcg.nl.
authors.forename: Thera P
authors.initials: TP
authors.lastname: Links
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019160:Endosonography / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D049268:Positron-Emission Tomography; D011877:Radionuclide Imaging; D014056:Tomography, X-Ray; D055815:Young Adult; D006623:von Hippel-Lindau Disease / Q000150:complications*