Nonfunctioning, small, incidental pancreatic neuroendocrine tumors: Results of a nonoperative approach cohort.
OBJECTIVE
The availability of new imaging techniques has conditioned an increase in the incidental diagnosis of small nonfunctioning pancreatic neuroendocrine tumors (PNET-NF). The best treatment is controversial, some authors advise a conservative approach in selected cases. Our aim is to analyze the evolution of incidental, small size PNET-NF, treated with clinical follow-up without surgery.


METHODS
We performed a retrospective analysis of a prospective database of patients diagnosed incidentally with PNET-NF since November 2007 to September 2015. We include those with PNET-NF ≤2cm and asymptomatic. The diagnosis was performed using imaging tests indicating endoscopic ultrasound-guided fine-needle aspiration in case of doubts in the diagnosis. The follow-up was performed at our center, registering clinical and/or radiological changes.


RESULTS
We included 24 patients with a median age of 70 years, and a similar distribution in terms of sex. The diagnosis was made through computed tomography multidetector or magnetic resonance imaging and octreotide scan. The tumors were located mainly in the head and neck (46%), with a mean size of 11,5±3,55mm at diagnosis (5-19mm). In 2 cases endoscopic ultrasound fine needle aspiration was used (8%), confirming the diagnosis of low-grade PNET with Ki67<5%. The median follow-up was 39 months (7-100). In 19 patients (79%) they remained the same size, 21% (5) increased its size with a mean of 2,6±2mm (1-6). No cases had progression of disease.


CONCLUSIONS
In selected patients, non-surgical management of PNET-NF is an option to consider, when they are asymptomatic and ≤2cm. Larger studies with more patients and more time of follow-up are needed to validate this non-operative approach.
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España.
Catalina
C
Uribe Galeano
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España. Electronic address: jfabregat@bellvitgehospital.cat.
Joan
J
Fabregat Prous
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España.
Juli
J
Busquets Barenys
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España.
Nuria
N
Pelaez Serra
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España.
Lluís
L
Secanella Medayo
Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat (Barcelona), España.
Emilio
E
Ramos Rubio
Servicio de Radiología. Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
Sandra
S
Ruiz Osuna
Servicio de Endocrinología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
Carlos
C
Villabona Artero
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D047368:Tumor Burden
Incidental; No funcionante; Non-functional; Pancreatic neuroendocrine tumors; Tamaño tumoral; Tumor neuroendocrino de páncreas; Tumor size