Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series.
OBJECTIVE
Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed.


METHODS
This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured.


RESULTS
A total of 80 patients (mean age: 58 +/- 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 +/- 8.5 mm vs 19.8 +/- 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor </=10 mm, and in a further 3 (15%) cases with a tumor diameter </=20 mm. CT overlooked the pancreatic lesion more frequently in patients with functioning than non-functioning p-NETs (46.5% vs 24.3%; P = 0.002). EUS allowed a more precise pre-operative tumor measurement, with an overall incorrect dimension in only 9 (11.2%) patients. Of note, the EUS-guided FNA suspected the neuroendocrine nature of tumor in all cases.


CONCLUSIONS
Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy. r.manta@libero.it.
Raffaele
R
Manta
Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.
Elisabetta
E
Nardi
Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Nico
N
Pagano
Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Claudio
C
Ricci
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
Mariano
M
Sica
Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.
Danilo
D
Castellani
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
Helga
H
Bertani
Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
Micaela
M
Piccoli
Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
Barbara
B
Mullineris
Endoscopy Unit, Niguarda Ca-Granda Hospital, Milan, Italy.
Alberto
A
Tringali
Gastroenterology Unit, Ospedali Riuniti Ancona, Italy.
Francesco
F
Marini
Gastroenterology Unit, Ospedali Riuniti Ancona, Italy.
Ugo
U
Germani
Pathology Unit Spedali Civili, Brescia, Italy.
Vincenzo
V
Villanacci
Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Riccardo
R
Casadei
Endoscopy Unit, Niguarda Ca-Granda Hospital, Milan, Italy.
Massimiliano
M
Mutignani
Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy.
Rita
R
Conigliaro
Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.
Gabrio
G
Bassotti
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Angelo
A
Zullo
D000328:Adult; D000368:Aged; D019160:Endosonography; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D047368:Tumor Burden