Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors.

Published on Oct 22, 2019in Endoscopy International Open
· DOI :10.1055/A-0967-4684
Leonardo Henry Eusebi25
Estimated H-index: 25
(UNIBO: University of Bologna),
Douglas Thorburn33
Estimated H-index: 33
(Royal Free Hospital)
+ 6 AuthorsStephen P. Pereira61
Estimated H-index: 61
(UCL: University College London)
Sources
Abstract
Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a method of obtaining preoperative diagnosis of pancreatic neuroendocrine tumors (PanNETs) has been reported in several series. Fine-needle biopsies (FNB) are increasingly employed to obtain core specimens during EUS. However, the differences in efficacy between these sampling methods in the diagnosis of PanNETs still needs to be defined. Patients and methods Over a 13-year period, all patients who underwent EUS-guided tissue sampling of suspicious pancreatic lesions with clinical, endoscopic and pathologic details were entered into an electronic database. Lesions underwent EUS-FNA or FNB sampling, or a combination of the two. The accuracy and safety of different EUS-guided sampling methods for confirmed PanNETs were investigated. Results A total of 91 patients (M/F: 42/49, median age: 57 years), who underwent 102 EUS procedures had a final diagnosis of PanNET. Both EUS-guided sampling modalities were used in 28 procedures, EUS-FNA alone was used in 61 cases, while EUS-FNB alone in 13 cases. Diagnostic yield of EUS-FNA and EUS-FNB alone, including the inadequate specimens, was 77.5 % (95 %CI: 68.9 – 86.2 %) and 85.4 % (95 %CI: 74.6 – 96.2 %), respectively. The combination of both sampling modalities established the diagnosis in 96.4 % of cases (27/28) (95 %CI: 89.6 – 100 %), significantly superior to EUS-FNA alone (P = 0.023). Diagnostic sensitivity among the adequate samples for EUS-FNA, EUS-FNB and for the combination of the two methods was 88.4 % (95 %CI: 80.9 – 96.0 %), 94.3 % (95 %CI: 86.6 – 100 %) and 100 % (95 %CI: 100 – 100 %). There was one reported complication, a post-FNA bleeding, treated conservatively. Conclusions EUS-FNB improves diagnostic sensitivity and confers additional information to cytological assessment of PanNETs.
📖 Papers frequently viewed together
12 Citations
85 Citations
References39
Newest
: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from the diffuse neuroendocrine system. They frequently originate in the gastroenteropancreatic (GEP) tract and the bronchopulmonary tree, and their incidence has steadily increased in the last 3 decades. Fundamental biologic and genomic differences underlie the clinical heterogeneity of NETs, and distinct molecular features characterize NETs of different grades and different primary sites. Although surgery remains the corners...
83 CitationsSource
#1Benjamin L. Witt (UofU: University of Utah)H-Index: 17
#2Rachel E. Factor (UofU: University of Utah)H-Index: 19
Last. Douglas G. Adler (UofU: University of Utah)H-Index: 65
view all 6 authors...
Background and Objectives: EUS guided core biopsy was once rarely performed but is now entering mainstream practice. Neuroendocrine tumors often warrant core biopsy as sufficient tissue must be obtained to allow for special staining to ensure a correct diagnosis. Traditionally these lesions were sampled with FNA needles. We performed a retrospective pilot study to evaluate the clinical value and efficacy of the a new EUS core needle biopsy needle as compared to a standard EUS FNA needle in the e...
15 CitationsSource
#1Per Hedenström (Sahlgrenska University Hospital)H-Index: 5
#2Akif Demir (Sahlgrenska University Hospital)H-Index: 3
Last. Riadh Sadik (Sahlgrenska University Hospital)H-Index: 19
view all 5 authors...
AbstractObjectives: Different diagnostic entities can present as solid pancreatic lesions (SPL). This study aimed to explore the utility of endoscopic ultrasound-guided reverse bevel fine-needle biopsy sampling (EUS-FNB) in SPLs.Material and methods: In 2012–2015, consecutive patients with SPLs were prospectively included in a tertiary center setting and subjected to dual needle sampling with a 22 gauge reverse bevel biopsy needle and a conventional 25 gauge open tip aspiration needle (EUS-FNA)....
12 CitationsSource
#1Arvind Dasari (University of Texas MD Anderson Cancer Center)H-Index: 24
#2Chan Shen (University of Texas MD Anderson Cancer Center)H-Index: 17
Last. James C. Yao (University of Texas MD Anderson Cancer Center)H-Index: 74
view all 8 authors...
Importance The incidence and prevalence of neuroendocrine tumors (NETs) are thought to be rising, but updated epidemiologic data are lacking. Objective To explore the evolving epidemiology and investigate the effect of therapeutic advances on survival of patients with NETs. Design, Setting, and Participants A retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 64 971 patients with...
801 CitationsSource
#1Leonardo Henry Eusebi (UCL: University College London)H-Index: 3
#1Leonardo Henry Eusebi (UNIBO: University of Bologna)H-Index: 25
Last. Douglas Thorburn (UCL: University College London)H-Index: 33
view all 8 authors...
2 CitationsSource
#1Susumu HijiokaH-Index: 26
#2Kazuo HaraH-Index: 33
Last. Kenji YamaoH-Index: 63
view all 17 authors...
Background Multiple studies have investigated sampling adequacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic neuroendocrine neoplasms (pNENs). However, none have described the diagnostic performance of EUS-FNA for pNENs, or the influencing factors. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA, with post-operative pathological diagnosis as the gold standard, and factors predictive of inadequate EUS sampling.
32 CitationsSource
#1Simron Singh (U of T: University of Toronto)H-Index: 13
#1Simron Singh (U of T: University of Toronto)H-Index: 27
Last. Calvin Law (U of T: University of Toronto)H-Index: 47
view all 13 authors...
Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades. Pancreatic NETs are categorized as functional (F) or nonfunctional (NF) based on their ability to secrete hormones that elicit clinically relevant symptoms. Specialized diagnostic tests are required for diagnosis. Treatment options are diverse and include surgical resection, intraarterial hepatic therapy, and peptide receptor radi...
44 CitationsSource
#1Carlo Fabbri (AUSL: Academy for Urban School Leadership)H-Index: 20
#2Carmelo LuigianoH-Index: 22
Last. Vincenzo Cennamo (AUSL: Academy for Urban School Leadership)H-Index: 28
view all 12 authors...
Background Early detection of small pancreatic cancer is important because expected survival is markedly better for tumors ≤2 cm. A new endoscopic ultrasound-(EUS) guided biopsy needle with side fenestration has been recently developed to enable fine-needle biopsy (FNB) under EUS guidance. The aim of this study was to evaluate the outcome of EUS–FNB using a 22-gauge ProCore needle in solid pancreatic lesions ≤2 cm, in terms of diagnostic accuracy and yield.
31 CitationsSource
#1Vikramjit Mitra (Freeman Hospital)H-Index: 2
#2Manu NayarH-Index: 13
Last. Kofi Oppong (National Health Service)H-Index: 22
view all 8 authors...
Background & Aims: Our study aimed to assess the sensitivity of EUS and EUS-FNA for pancreatic neuroendocrine 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 ...
17 CitationsSource
113k Citations
Cited By5
Newest
Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing a higher tumor detection rate than other imaging modalities, especially for small size lesions. EUS also serves as a guide for preoperative sampling and other interventi...
Source
Organoboron compounds have been playing an increasingly important role in analytical chemistry, material science, health applications, and particularly as functional polymers like boron carriers for cancer therapy. There are two main applications of boron isotopes in radiation cancer therapy, Boron Neutron Capture Therapy and Proton Boron Fusion Therapy. In this study, a novel and original material consisting of a three-dimensional polymer network crosslinked with [Formula: see text]B enriched b...
Source
#1Tatsuya IshiiH-Index: 2
#2Akio KatanumaH-Index: 2
Last. Kuniyuki TakahashiH-Index: 21
view all 8 authors...
Although pancreatic neuroendocrine neoplasms (PNENs) are relatively rare tumors, their number is increasing with advances in diagnostic imaging modalities. Even small lesions that are difficult to detect using computed tomography or magnetic resonance imaging can now be detected with endoscopic ultrasound (EUS). Contrast-enhanced EUS is useful, and not only diagnosis but also malignancy detection has become possible by evaluating the vascularity of tumors. Pathological diagnosis using EUS with f...
Source
#1Fausto RosaH-Index: 25
#2Mihai Rimbaș (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 2
Last. Alberto LarghiH-Index: 30
view all 10 authors...
Background and study aims Pancreatic neuroendocrine tumors (pNETs) can be difficult to detect intra-operatively. The aim of this paper is to evaluate the safety and efficacy of preoperative endoscopic ultrasound guided fine needle tattooing (EUS-FNT) to facilitate intra-operative detection of pNETs. Patients and methods Sixteen patients with pNETs (8 insulinoma and 8 non-functional pancreatic neuroendocrine tumors) underwent EUS-FNT. The procedure was carried out using the conventional curviline...
Source
Source
#1Fumitaka Niiya (Showa University)H-Index: 3
#2Yuichi Takano (Showa University)H-Index: 6
Last. Masatsugu Nagahama (Showa University)H-Index: 8
view all 11 authors...
Mixed acinar-neuroendocrine carcinoma (MAEC) of the pancreas is a rare entity, and obtaining a preoperative diagnosis is difficult. We report a case of pancreatic MAEC successfully diagnosed with EUS-FNA. The case was a 72-year-old male with upper abdominal pain. Abdominal CT showed an irregular, hypovascular tumor of pancreatic tail. EUS-FNA was performed using a 22G needle. Immunostaining revealed positive results for the acinar marker trypsin and the neuroendocrine markers chromogranin A and ...
Source
Endoscopic ultrasound-guided tissue acquisition is now an imperative technique for the diagnosis of multiple diseases in the gastrointestinal tract and nearby structures. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and fine needle biopsy via dedicated FNB needles (EUS-FNB) are two standard-essential tools for tissue acquisition. The choice of needle type is an important factor determining appropriate tissue acquisition. Multiple studies have compared EUS-FNA versus EUS-FNB on d...
Source
#1Diogo Turiani Hourneaux de Moura (USP: University of São Paulo)H-Index: 19
#2Thomas R. McCarty (Harvard University)H-Index: 22
Last. Christopher C. Thompson (Harvard University)H-Index: 59
view all 8 authors...
Background and study aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. The aim of this study was to compare diagnostic yield and safety between EUS-FNA and EUS-FNB in sampling of pancreatic masses. Patients and methods This was a multicenter retrospective study to e...
1 CitationsSource