EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors

doi:10.1016/j.gie.2010.08.030

Gastrointestinal Endoscopy

Volume 73, Issue 4, April 2011, Pages 691-696

https://doi.org/10.1016/j.gie.2010.08.030 Get rights and content

Background

The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging.

Objective

The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs.

Design

Retrospective single-center cohort study.

Setting

Johns Hopkins Hospital.

Patients

Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded.

Main Outcome Measurement

Detection rates of CT and EUS were compared by using pathology as the reference standard.

Results

In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ² for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%).

Limitations

Retrospective nonrandomized design and referral bias.

Conclusions

The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.

Section snippets

Patients and methods

Our prospective pathology database was queried for PNETs that were resected at Johns Hopkins Hospital (JHH) from May 1984 to August 2009. Patients with PNETs that were found incidentally in pancreatic specimens resected for other primary pathologies and those who did not undergo CT examination at JHH were excluded from the study. At our center, 4-detector CT was introduced in 1990, 16-detector in mid-1996, and 64-detector in mid-2002. The study was approved by the Institutional Review Board for

Results

During the study period, 385 patients with ≥1 PNET underwent surgical resection at our institution. After excluding 40 PNETs that were found incidentally in surgical specimens resected for other primary pancreatic pathologies (most commonly pancreatic adenocarcinoma) and 128 without a JHH CT, we studied 217 patients (Fig. 1) with 231 PNETs (female, 52%; mean age, 56 years; mean tumor diameter, 32.7 mm ± 30 mm). The mean size of insulinomas was significantly smaller than that of noninsulinomas

Discussion

The present study reports a large radiologic and EUS series of pathologically proven PNETs. During a 26-year period, 385 patients with ≥1 PNET underwent resection at our hospital. We excluded all patients who did not undergo CT examination at JHH to ensure homogeneity of the data. Our study cohort included 217 patients with 231 PNETs: 173 (74.9%) nonfunctional PNETs and 58 (25.1%) functional PNETs. Insulinomas accounted for the majority (60.3%) of functional PNETs. In most older series,

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: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

: If you would like to chat with an author of this article, you may contact Dr Canto at [email protected].

: See CME section; p. 798.

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Original articleClinical endoscopyEUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors

Background

Objective

Design

Setting

Patients

Main Outcome Measurement

Results

Limitations

Conclusions

Section snippets

Patients and methods

Results

Discussion

Best Pract Res Clin Gastroenterol

Hum Pathol

Gastrointest Endosc

Eur J Surg Oncol

Dig Liver Dis

Best Pract Res Clin Endocrinol Metab

Best Pract Res Clin Endocrinol Metab

Gastrointest Endosc

Am J Gastroenterol

Eur J Ultrasound

Gastrointest Endosc

Gastrointest Endosc

Best Pract Res Clin Endocrinol Metab

Hematol Oncol Clin North Am

Adv Surg

Original article
Clinical endoscopy
EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors