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Article11, 3/2016

ORIGINAL PAPER

Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series

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Raffaele Manta1, Elisabetta Nardi2, Nico Pagano3, Claudio Ricci3, Mariano Sica1, Danilo Castellani2, Helga Bertani1, Micaela Piccoli4, Barbara Mullineris4, Alberto Tringali5, Francesco Marini6, Ugo Germani6, Vincenzo Villanacci7, Riccardo Casadei3, Massimiliano Mutignani5Rita Conigliaro1, Gabrio Bassotti2, Angelo Zullo8

1) Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant’Agostino-Estense, Baggiovara-Modena;
2) Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia;
3) Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna;
4) Department of General Surgery, Nuovo Ospedale Civile Sant’Agostino-Estense, Baggiovara-Modena;
5) Endoscopy Unit, Niguarda Ca-Granda Hospital, Milan;
6) Gastroenterology Unit, Ospedali Riuniti Ancona;
7) Pathology Unit Spedali Civili, Brescia;
8) Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.253.ned

ABSTRACT
Background & Aims: 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.

Key words: neuroendocrine tumor – pancreas – diagnosis – endoscopic ultrasonography – computed tomography.

Abbrevations: CgA: chromogranin A; EUS: Endoscopic Ultrasonography; FNA: fine-needle aspiration; p-NETs: pancreatic neuroendocrine tumors.