Pancreatic Endocrine Tumors

Figueiredo, Fábio P.; Giovannini, Marc; Monges, Geneviève; Charfi, Slim; Bories, Erwan; Pesenti, Christian; Caillol, Fabrice; Delpero, Jean‐Robert

doi:10.1097/mpa.0b013e3181b365db

Cited by 45 publications

(19 citation statements)

References 25 publications

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“…They have a typical appearance in EUS-E and CED-EUS as previously shown by Dietrich et al . (2008) and by our own group (2009) 1213. They have a hypoechoic region in the center with a green appearance in the small area surrounded by blue or harder tissue and a SR usually less than 10 in EUS-E.…”

Section: Discussionmentioning

confidence: 96%

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

Figueiredo

Silva

Monges

et al. 2012

Endosopic Ultrasound

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Objective:Although endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the gold standard for diagnosing pancreatic lesions, its negative predictive value is suboptimal. Our aim was to evaluate the yield of contrast-enhanced EUS (CED-EUS) and of strain ratio EUS-elastography (SR-E-EUS) for differentiating pancreatic solid lesions.Methods:Forty-seven patients (27 men, 20 women, 70 ± 11 years) were consecutively involved in this single-center, prospective study. They were submitted to EUS, SR-E-EUS, CED-EUS with Sonovue®, and EUS-FNA. The final diagnosis was based on the histological assessment of EUS-FNA and/or surgical specimens when available, and on follow-up of at least 6 months.Results:From the 47 focal pancreatic lesions included, 13 (28%) were benign and 34 (72%) malignant. Patients with malignancy were older (70 ± 11 vs. 61 ± 8, P = 0.003), and had larger lesions (34 ± 12 mm vs. 22 ± 11 mm, P = 0.03). Malignant lesions had higher SR-E-EUS (31 ± 32 vs. 8 ± 9, P = 0.001) and more hypovascular pattern (93% vs. 33%, P < 0.001). Logistic regression determined that only hypovascularity (OR = 2.6, 95%CI: 1.5-130, P = 0.02) was independently predictive of malignancy. ROC analysis for SR-E-EUS yielded an optimal cutoff of 8 (AUC 0.91, 95%CI: 0.74-0.98) for the best power distinction for malignancy. There was no significant difference concerning sensitivity (79%, 90%, 93%) and specificity rates (85%, 75%, 67%) of EUS-FNA, SR-E-EUS, and CED-EUS, respectively. By analysis of the inconclusive EUS-FNA subset (9 patients, 19%), SR-E-EUS > 8 and hypovascularity showed sensitivity of 80% and 100%, and specificity of 67% and 67%, respectively.Conclusion:The clinical utility of CED-EUS and SR-E-EUS remains questionable. The accuracies of CED-EUS and SR-E-EUS are similar to EUS-FNA. Hypovascularity was independently predictive of malignancy. Patients with inconclusive EUS-FNA could benefit from CED-EUS due to the high sensitivity of hypovascularity for diagnosing malignancy.

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Section: Discussionmentioning

confidence: 96%

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

Figueiredo

Silva

Monges

et al. 2012

Endosopic Ultrasound

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“…However, EUS is not generally recommended at present in all MEN1 patients, because routine surgical resection of small p-NETs (<2 cm) is not recommended and the EUS criteria on when to operate on these patients are not established [8,11,124,125]. Some experts recommended pancreatic EUS in selected MEN1 patients, especially if they have ZES or small non-functional p-NETs on other imaging studies and are being followed without surgery, in an attempt to detect small non-functional tumors and to follow their growth in order to offer earlier surgery [8,124,125,126]. 68 Ga-PET/CT is more sensitive than any of the other modalities, however its use remains investigational, and its role has not been defined in MEN1 patients [94].…”

Section: Localization Of Tumor/tumor Extent In Patients With Functionmentioning

confidence: 99%

ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Functional Pancreatic Endocrine Tumor Syndromes

Jensen¹,

et al. 2012

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“…For instances, it has a high sensitivity and diagnostic accuracy for the evaluation of neuroendocrine tumors. [4546] Even more, EUS-FNA is very helpful in assessing the malignant behavior of this type of pancreatic tumors, being able also to predict 5-year survival. [4748] Determination of Ki-67 expression, key in the evaluation of neuroendocrine tumors, can also be evaluated in EUS-FNA samples.…”

Section: Usefulness Of Eus-fna In the Differential Diagnosis Of Solidmentioning

confidence: 99%

When to puncture, when not to puncture: Pancreatic masses

2014

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Endoscopic ultrasound (EUS) has evolved to become a crucial tool for the evaluation of pancreatic diseases, among them solid pancreatic lesions. However, its ability to determine whether a lesion is malignant or not is difficult to establish based only in the endosonographic image. EUS-guided fine needle aspiration (EUS-FNA) allows obtaining a cytological and/or histological sample from pancreatic lesions, with a high overall accuracy and low complication rates. Although the clinical usefulness of EUS-FNA for pancreatic diseases is widely accepted, the indications for tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic accuracy and complications of EUS-FNA, focusing on its current indications.

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Pancreatic Endocrine Tumors

Abstract: Nonfunctional PETs were more common and advanced. The EUS-FNA has a high accuracy for diagnosing PETs. Progression and poorer survival were associated with TNM stage.

Cited by 45 publications

References 25 publications

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Functional Pancreatic Endocrine Tumor Syndromes

When to puncture, when not to puncture: Pancreatic masses

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