Cystic pancreatic neuroendocrine tumors: endoscopic ultrasound and fine-needle aspiration characteristics

Yoon, Won Jae; Daglilar, Ebubekir; Pitman, Martha B.; Brugge, William R.

doi:10.1055/s-0032-1325990

Cited by 56 publications

(38 citation statements)

References 18 publications

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“…Whilst the number of cases is too small to draw any definitive conclusions this improvement in diagnostic performance is possibly due to a combination of increased awareness among endosonographers and cytopathologists, and in addition, a reduction in unsatisfactory aspirates through the use of LBC for processing. The median CEA was low (1.4 ng/ml) which is in accordance with previous studies [26][27][28].…”

Section: Discussionsupporting

confidence: 92%

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Diagnostic Performance of Endoscopic Ultrasound (EUS)/ Endoscopic Ultrasound – Fine Needle Aspiration (EUS-FNA) Cytology in Solid and Cystic Pancreatic Neuroendocrine Tumours

Mitra¹,

Nayar²,

Leeds³

et al. 2015

JGLD

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Background & Aims: Our study aimed to assess the sensitivity of EUS and EUS-FNA for pancreatic neuro-endocrine tumors (pNETs) and compare performance over two consecutive 4 year 2 month periods, to investigate the comparative performance between solid and cystic pNETs and determine the incremental yield of EUS±FNA in individuals with a mass not diagnosed as a pNET after cross-sectional imaging.Methods: A retrospective review of a prospectively maintained database was carried out to identify all pNET patients who underwent EUS-FNA between April 2003 and September 2011.Results: A final diagnosis of solid and cystic pNETs was made in 43 and 10 patients, respectively. Overall, the yield of combined EUS imaging and cytology was significantly higher than that of CT and/or MRI (p< 0.05) across all groups [solid (83.7% vs. 41.8%), cystic (70% vs. 10%) and combined solid-cystic (81.1% vs. 35.8%)]. The yield of combined EUS imaging and cytology was significantly better than EUS imaging alone (p<0.05) in the solid (83.7% vs. 58%) and combined pNET cohort (81.1% vs. 52.8%) of patients. After a non-diagnostic CT and or MRI, EUS/EUS-FNA confirmed pNET in 19 out of 25 patients (76.0%) with solid pNETs and 6 out of 9 patients (66.7%) with cystic pNETs.Conclusion: EUS and EUS-FNA had a significant clinical impact in the 25/34 of cases where pNET was not suspected after initial cross-sectional imaging.

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Section: Discussionsupporting

confidence: 92%

“…EUS-FNA sensitivity in this series was 71%. Another study by Yoon et al [27] reporting on 19 cases of cystic pNETs, documented a EUS-FNA yield of 63.2%. A further study by Morales-Oyarvide et al [15] reporting on 33 cases of cystic pNETs, documented a EUS-FNA yield of 71%.…”

Section: Discussionmentioning

confidence: 96%

Diagnostic Performance of Endoscopic Ultrasound (EUS)/ Endoscopic Ultrasound – Fine Needle Aspiration (EUS-FNA) Cytology in Solid and Cystic Pancreatic Neuroendocrine Tumours

Mitra¹,

Nayar²,

Leeds³

et al. 2015

JGLD

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“…44 A majority of cystic-NETs are indistinguishable from other PCLs on preoperative imaging and cyst-fluid CEA levels are generally very low; however, the yield of EUS-FNA cytology is high (73%) compared to other PCLs (20%). 44,45 Integration of Molecular Testing in the Management of Pancreatic Cysts…”

Section: Other Pancreatic Cystic Lesionsmentioning

confidence: 99%

An appraisal of pancreatic cyst fluid molecular markers

Modi

Pavurala

Krishna

2017

Int J Gastrointest Interv

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Pancreatic malignancy is the third leading cause of cancer related death in the United States with limited viable screening options. By the end of this decade, cancers are poised to become the leading cause of death with pancreatic cancer projected to be the second leading cause of cancer related mortality. Pancreatic cystic lesions (PCLs) are found in approximately 5%-14% of patients due to the increased utilization of cross-sectional imaging, with approximately 8%-10% of pancreatic cancers originating as PCLs. Current screening guidelines have shown discrepancies between morphologic characteristics of PCLs and identifying advanced pancreatic disease. Molecular analysis has emerged as a novel technology to aid in adequate diagnosis and management decisions of PCLs. Mucinous cysts including intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms have similar oncogenic mutations including KRAS, TP53, SMAD4, PIK3CA, PTEN, or CKDN2A, while GNAS and RNF43 mutations are specific only to IPMNs. Serous cystadenomas have been associated with a loss of tumor suppressor gene VHL, while solid-psuedopapillary neoplasms have an oncogenic mutation CTNNB1. A specific molecular marker to diagnose existing high-grade dysplasia or impending malignant transformation is yet to be identified. Moving forward it is important to advance technology in isolating and identifying high-risk molecular markers from cyst fluid while considering their increased utilization in the evaluation of PCLs.

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“…Tumor size, production of hormones, and cytological atypia do not correlate with biological behavior, so despite the malignant potential of tumors > 0.5 cm, these well-differentiated tumors are classified as neoplasms and not carcinomas histologically or cytologically. Cytological Criteria [4][5][6]: Pancreatic Neuroendocrine Tumor…”

Section: Pancreatic Neuroendocrine Tumormentioning

confidence: 99%

Category IV: Neoplastic: Other

Pitman

Layfield

2015

The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology

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Cystic pancreatic neuroendocrine tumors: endoscopic ultrasound and fine-needle aspiration characteristics

Abstract: Analysis of EUS and FNA results showed that the cyst fluid from CPanNets had a lower CEA concentration, a higher frequency of thick walls on EUS, and higher diagnostic cytology compared with mucinous cysts. These findings may aid in the diagnosis of CPanNets.

Cited by 56 publications

References 18 publications

Diagnostic Performance of Endoscopic Ultrasound (EUS)/ Endoscopic Ultrasound – Fine Needle Aspiration (EUS-FNA) Cytology in Solid and Cystic Pancreatic Neuroendocrine Tumours

Diagnostic Performance of Endoscopic Ultrasound (EUS)/ Endoscopic Ultrasound – Fine Needle Aspiration (EUS-FNA) Cytology in Solid and Cystic Pancreatic Neuroendocrine Tumours

An appraisal of pancreatic cyst fluid molecular markers

Category IV: Neoplastic: Other

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