Fine-Needle Aspiration Cytology in the Diagnosis of Pancreatic Neuroendocrine Tumors: A Single-Center Experience of 25 Cases

Abstract

Objective: Pancreatic neuroendocrine tumors (Pan NETs) are rare but are being increasingly diagnosed. The objective of this retrospective study was to share our experience of fine-needle aspiration (FNA), including endoscopic ultrasound-guided FNA with rapid on-site evaluation (ROSE), with the use of immunohistochemical (IHC) markers in the diagnosis of Pan NET. Study Design: A total of 25 cases of Pan NET diagnosed on pancreatic FNA between 2008 and 2013 were identified from our hospital database. Clinical history, radiology, cytomorphological features, and IHC performed were reviewed. Results: The mean age of our patient group was 52 years; 15/25 were male. Most presented with abdominal pain and the majority of the lesions were in the pancreatic body, the largest being 14 cm in size. Based on the 2010 World Health Organization criteria, cases were further graded as follows: 21 cases were grade 1, 2 cases were grade 2 and 2 cases were grade 3. Proliferation marker Ki-67 was utilized in 6 cases for definitive grading. Of the 25 cases, 23 were diagnosed as nonfunctional while 2 were functional; 1 patient had MEN-1 syndrome and 1 had von Recklinghausen's syndrome. Conclusions: Our data suggests that FNA, with ROSE and IHC markers, is highly sensitive and specific for diagnosing Pan NET.

The role of rapid on‐site evaluation on diagnostic accuracy of endoscopic ultrasound fine needle aspiration for pancreatic, submucosal upper gastrointestinal tract and adjacent lesions

“…People who oppose ROSE either lack funding for the pathologist time and therefore defend their house policy or lack expertise of rapid onsite cytology which is equivalent to frozen section and has to be trained or work from a site remote to the procedure and are physically unable to attend. Among practitioners, ROSE availability was and still believed to improve the diagnostic accuracy of EUS‐FNA . Our study showed that performing ROSE was associated with high compatibility rate with the final histopathological diagnosis and yielded high sensitivity, specificity, negative predictive value and positive predictive value for all lesions (98.3%, 70%, 87.5%, 95%) and for a subgroup of pancreatic lesions (97.8%, 75%, 85.7%, 95.8%).…”

Surgery management for sporadic small (≤2 cm), non-functioning pancreatic neuroendocrine tumors: A consensus statement by the Chinese Study Group for Neuroendocrine Tumors (CSNET)

“…Similar to other pancreatic lesions, NF-pNETs may be further evaluated by sampling these tumors by FNA performed during the EUS examination to optimize patient management (21). Studies have reported sensitivities of 61-84% and overall accuracy of up to 92.5% of EUS-FNA in establishing the diagnosis of pNETs (22)(23)(24). Alternative methods for obtaining tissue by EUS have been evaluated to overcome the limitations of FNA.…”

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review

“…It should be noticed that out of the seven included articles, only one reported improved adequacy with the service of ROSE [ 9 ]. In the past decade, service of ROSE is generally believed to bring high adequate rate in the procedure of EUS-FNA [ 23 – 26 ]. However, most of evidence for pancreatic lesions were collected from single-cohort studies [ 27 – 30 ], which had low power to detect the impact of ROSE.…”