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Endoscopic Approaches for Diagnosis of Pancreatic Neuroendocrine Tumors

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Management of Pancreatic Neuroendocrine Tumors

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Abstract

Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms comprising only 1 % to 2 % of all pancreatic tumors. In recent years, the number of incidentally discovered PNETs has greatly increased given the widespread use of axial imaging. However, a significant proportion of PNETs may not be visualized on conventional imaging such as computed tomography, magnetic resonance imaging, and somatostatin receptor scintigraphy. Endoscopic ultrasound (EUS) has become an integral part of the diagnosis of PNETs because of its high sensitivity for detecting, localizing, and diagnosing PNETs. EUS-guided tissue acquisition provides histologic and immunologic confirmation, and may also allow prognostication about tumor behavior. In addition to preoperative assessment of these tumors, EUS has also been shown to have an important role in nonoperative management of small nonfunctional PNETs. Finally, recent developments suggest that interventional EUS may be used to aid intraoperative localization of PNETs and to deliver therapeutic agents for the treatment of PNETs.

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References

  1. Oberg K, Eriksson B. Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol. 2005;19:753–81.

    Article  PubMed  Google Scholar 

  2. Rustagi T, Rai M, Bauer F. Non-functional pancreatic neuroendocrine tumor as an incidentaloma—a case report and review of literature. J Gastrointest Cancer. 2013;44:336–42.

    Article  PubMed  Google Scholar 

  3. Kloppel G, Anlauf M. Epidemiology, tumour biology and histopathological classification of neuroendocrine tumours of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2005;19:507–17.

    Article  PubMed  Google Scholar 

  4. Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469–92.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008;19:1727–33.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Fesinmeyer MD, Austin MA, Li CI, De Roos AJ, Bowen DJ. Differences in survival by histologic type of pancreatic cancer. Cancer Epidemiol Biomarkers Prev. 2005;14:1766–73.

    Article  PubMed  Google Scholar 

  7. Massironi S, Sciola V, Peracchi M, Ciafardini C, Spampatti MP, Conte D. Neuroendocrine tumors of the gastro-entero-pancreatic system. World J Gastroenterol. 2008;14:5377–84.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jensen RT, Berna MJ, Bingham DB, Norton JA. Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer. 2008;113:1807–43.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gibril F, Schumann M, Pace A, Jensen RT. Multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome: a prospective study of 107 cases and comparison with 1009 cases from the literature. Medicine (Baltimore). 2004;83:43–83.

    Article  Google Scholar 

  10. Kang CM, Park SH, Kim KS, Choi JS, Lee WJ, Kim BR. Surgical experiences of functioning neuroendocrine neoplasm of the pancreas. Yonsei Med J. 2006;47:833–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bilimoria KY, Talamonti MS, Tomlinson JS, et al. Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: analysis of 3851 patients. Ann Surg. 2008;247:490–500.

    Article  PubMed  Google Scholar 

  12. Ehehalt F, Saeger HD, Schmidt CM, Grutzmann R. Neuroendocrine tumors of the pancreas. Oncologist. 2009;14:456–67.

    Article  PubMed  CAS  Google Scholar 

  13. Falconi M, Plockinger U, Kwekkeboom DJ, et al. Well-differentiated pancreatic nonfunctioning tumors/carcinoma. Neuroendocrinology. 2006;84:196–211.

    Article  PubMed  CAS  Google Scholar 

  14. Bilimoria KY, Tomlinson JS, Merkow RP, et al. Clinicopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9,821 patients. J Gastrointest Surg. 2007;11:1460–7. discussion 7-9.

    Article  PubMed  Google Scholar 

  15. Vagefi PA, Razo O, Deshpande V, et al. Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977 to 2005. Arch Surg. 2007;142:347–54.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992;326:1721–6.

    Article  PubMed  CAS  Google Scholar 

  17. Kim MK. Endoscopic ultrasound in gastroenteropancreatic neuroendocrine tumors. Gut Liver. 2012;6:405–10.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee LS. Diagnosis of pancreatic neuroendocrine tumors and the role of endoscopic ultrasound. Gastroenterol Hepatol. 2010;6:520–2.

    Google Scholar 

  19. Ishikawa T, Itoh A, Kawashima H, et al. Usefulness of EUS combined with contrast-enhancement in the differential diagnosis of malignant versus benign and preoperative localization of pancreatic endocrine tumors. Gastrointest Endosc. 2010;71:951–9.

    Article  PubMed  Google Scholar 

  20. Akerstrom G, Hellman P. Surgery on neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab. 2007;21:87–109.

    Article  PubMed  Google Scholar 

  21. Pais SAMK, Leblanc JK, et al. Clinical and endoscopic ultrasound morphology characteristics of pancreatic neuroendocrine tumors: a large, single center experience. Gastrointest Endosc. 2007;65:AB296.

    Google Scholar 

  22. Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M. Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc. 2007;65:788–97.

    Article  PubMed  Google Scholar 

  23. Tox U, Hackenberg R, Stelzer A, et al. Endosonographic diagnosis of solid pancreatic tumors: a retrospective analysis from a tertiary referral center. Z Gastroenterol. 2007;45:307–12.

    Article  PubMed  CAS  Google Scholar 

  24. O’Neil JMA-HM, Leblanc J, et al. Endoscopic ultrasound morphology features and initial detection of metastatic liver lesions from primary pancreatic adenocarcinoma and pancreatic neuroendocrine carcinoma. Gastrointest Endosc. 2008;67:AB217–8.

    Article  Google Scholar 

  25. Bordeianou L, Vagefi PA, Sahani D, et al. Cystic pancreatic endocrine neoplasms: a distinct tumor type? J Am Coll Surg. 2008;206:1154–8.

    Article  PubMed  Google Scholar 

  26. Kongkam P, Al-Haddad M, Attasaranya S, et al. EUS and clinical characteristics of cystic pancreatic neuroendocrine tumors. Endoscopy. 2008;40:602–5.

    Article  PubMed  CAS  Google Scholar 

  27. Goh BK, Ooi LL, Tan YM, et al. Clinico-pathological features of cystic pancreatic endocrine neoplasms and a comparison with their solid counterparts. Eur J Surg Oncol. 2006;32:553–6.

    Article  PubMed  CAS  Google Scholar 

  28. Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status. AJR Am J Roentgenol. 1995;165:1175–9.

    Article  PubMed  CAS  Google Scholar 

  29. Ho HC, Eloubeidi MA, Siddiqui UD, et al. Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours: a multicentre case series. Dig Liver Dis. 2013;45:750–3.

    Article  PubMed  Google Scholar 

  30. Jani N, Khalid A, Kaushik N, et al. EUS-guided FNA diagnosis of pancreatic endocrine tumors: new trends identified. Gastrointest Endosc. 2008;67:44–50.

    Article  PubMed  Google Scholar 

  31. Ahrendt SA, Komorowski RA, Demeure MJ, Wilson SD, Pitt HA. Cystic pancreatic neuroendocrine tumors: is preoperative diagnosis possible? J Gastrointest Surg. 2002;6:66–74.

    Article  PubMed  Google Scholar 

  32. Deshpande V, Lauwers GY. Cystic pancreatic endocrine tumor: a variant commonly confused with cystic adenocarcinoma. Cancer. 2007;111:47–53.

    Article  PubMed  Google Scholar 

  33. Federle MP, McGrath KM. Cystic neoplasms of the pancreas. Gastroenterol Clin North Am. 2007;36:365–76. ix.

    Article  PubMed  Google Scholar 

  34. Pais SA, Al-Haddad M, Mohamadnejad M, et al. EUS for pancreatic neuroendocrine tumors: a single-center, 11-year experience. Gastrointest Endosc. 2010;71:1185–93.

    Article  PubMed  Google Scholar 

  35. Baker MS, Knuth JL, DeWitt J, et al. Pancreatic cystic neuroendocrine tumors: preoperative diagnosis with endoscopic ultrasound and fine-needle immunocytology. J Gastrointest Surg. 2008;12:450–6.

    Article  PubMed  Google Scholar 

  36. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. 2000;95:2271–7.

    Article  PubMed  CAS  Google Scholar 

  37. Gouya H, Vignaux O, Augui J, et al. CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am J Roentgenol. 2003;181:987–92.

    Article  PubMed  Google Scholar 

  38. Ardengh JC, Rosenbaum P, Ganc AJ, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc. 2000;51:552–5.

    Article  PubMed  CAS  Google Scholar 

  39. Sotoudehmanesh R, Hedayat A, Shirazian N, et al. Endoscopic ultrasonography (EUS) in the localization of insulinoma. Endocrine. 2007;31:238–41.

    Article  PubMed  CAS  Google Scholar 

  40. Puli SR, Kalva N, Bechtold ML, et al. Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: a systematic review and meta analysis. World J Gastroenterol. 2013;19:3678–84.

    Article  PubMed  PubMed Central  Google Scholar 

  41. McLean AM, Fairclough PD. Endoscopic ultrasound in the localisation of pancreatic islet cell tumours. Best Pract Res Clin Endocrinol Metab. 2005;19:177–93.

    Article  PubMed  CAS  Google Scholar 

  42. Kann PH. The value of endoscopic ultrasound in localizing gastrinoma. Wien Klin Wochenschr. 2007;119:585–7.

    Article  PubMed  Google Scholar 

  43. Patel KK, Kim MK. Neuroendocrine tumors of the pancreas: endoscopic diagnosis. Curr Opin Gastroenterol. 2008;24:638–42.

    Article  PubMed  Google Scholar 

  44. Kann PH, Wirkus B, Keth A, Goitom K. Pitfalls in endosonographic imaging of suspected insulinomas: pancreatic nodules of unknown dignity. Eur J Endocrinol. 2003;148:531–4.

    Article  PubMed  CAS  Google Scholar 

  45. Kann PH, Ivan D, Pfutzner A, Forst T, Langer P, Schaefer S. Preoperative diagnosis of insulinoma: low body mass index, young age, and female gender are associated with negative imaging by endoscopic ultrasound. Eur J Endocrinol. 2007;157:209–13.

    Article  PubMed  CAS  Google Scholar 

  46. Klapman JB, Logrono R, Dye CE, Waxman I. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol. 2003;98:1289–94.

    Article  PubMed  Google Scholar 

  47. Alsohaibani F, Girgis S, Sandha GS. Does onsite cytotechnology evaluation improve the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy? Can J Gastroenterol. 2009;23:26–30.

    PubMed  PubMed Central  Google Scholar 

  48. LeBlanc JK, Ciaccia D, Al-Assi MT, et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc. 2004;59:475–81.

    Article  PubMed  Google Scholar 

  49. Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc. 2000;51:184–90.

    Article  PubMed  CAS  Google Scholar 

  50. Chang F, Chandra A, Culora G, Mahadeva U, Meenan J, Herbert A. Cytologic diagnosis of pancreatic endocrine tumors by endoscopic ultrasound-guided fine-needle aspiration: a review. Diagn Cytopathol. 2006;34:649–58.

    Article  PubMed  Google Scholar 

  51. Chang F, Vu C, Chandra A, Meenan J, Herbert A. Endoscopic ultrasound-guided fine needle aspiration cytology of pancreatic neuroendocrine tumours: cytomorphological and immunocytochemical evaluation. Cytopathology. 2006;17:10–7.

    Article  PubMed  CAS  Google Scholar 

  52. Pais SMK, Leblanc J, et al. Utility of EUSFNA in the diagnosis of pancreatic neuroendocrine tumors: correlation with histopathology in 76 patients. Gastrointest Endosc. 2007;65:AB304.

    Google Scholar 

  53. Atiq M, Bhutani MS, Bektas M, et al. EUS-FNA for pancreatic neuroendocrine tumors: a tertiary cancer center experience. Dig Dis Sci. 2012;57:791–800.

    Article  PubMed  CAS  Google Scholar 

  54. Wittmann J, Kocjan G, Sgouros SN, Deheragoda M, Pereira SP. Endoscopic ultrasound-guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study. Cytopathology. 2006;17:27–33.

    Article  PubMed  CAS  Google Scholar 

  55. Varadarajulu S, Fraig M, Schmulewitz N, et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy. 2004;36:397–401.

    Article  PubMed  CAS  Google Scholar 

  56. Al-Haddad M, Gill KR, Raimondo M, et al. Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study. Endoscopy. 2010;42:127–32.

    Article  PubMed  CAS  Google Scholar 

  57. Al-Haddad M, Raimondo M, Woodward T, et al. Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study. Gastrointest Endosc. 2007;65:894–8.

    Article  PubMed  Google Scholar 

  58. Nodit L, McGrath KM, Zahid M, et al. Endoscopic ultrasound-guided fine needle aspirate microsatellite loss analysis and pancreatic endocrine tumor outcome. Clin Gastroenterol Hepatol. 2006;4:1474–8.

    Article  PubMed  CAS  Google Scholar 

  59. Piani C, Franchi GM, Cappelletti C, et al. Cytological Ki-67 in pancreatic endocrine tumours: an opportunity for pre-operative grading. Endocr Relat Cancer. 2008;15:175–81.

    Article  PubMed  Google Scholar 

  60. Thomas-Marques L, Murat A, Delemer B, et al. Prospective endoscopic ultrasonographic evaluation of the frequency of nonfunctioning pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1. Am J Gastroenterol. 2006;101:266–73.

    Article  PubMed  Google Scholar 

  61. Kann PH, Kann B, Fassbender WJ, Forst T, Bartsch DK, Langer P. Small neuroendocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1): least significant change of tumor diameter as determined by endoscopic ultrasound (EUS) imaging. Exp Clin Endocrinol Diabetes. 2006;114:361–5.

    Article  PubMed  CAS  Google Scholar 

  62. Lee LC, Grant CS, Salomao DR, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012;152:965–74.

    Article  PubMed  Google Scholar 

  63. Alsohaibani F, Bigam D, Kneteman N, Shapiro AM, Sandha GS. The impact of preoperative endoscopic ultrasound on the surgical management of pancreatic neuroendocrine tumours. Can J Gastroenterol. 2008;22:817–20.

    PubMed  PubMed Central  Google Scholar 

  64. Lewis MA, Thompson GB, Young Jr WF. Preoperative assessment of the pancreas in multiple endocrine neoplasia type 1. World J Surg. 2012;36:1375–81.

    Article  PubMed  Google Scholar 

  65. Zhang T, Mu Y, Qu L, et al. Accurate combined preoperative localization of insulinomas aid the choice for enucleation: a single institution experience over 25 years. Hepatogastroenterology. 2012;59:1282–5.

    Article  PubMed  Google Scholar 

  66. Varma V, Tariciotti L, Coldham C, Taniere P, Buckels JA, Bramhall SR. Preoperative localisation and surgical management of insulinoma: single centre experience. Dig Surg. 2011;28:63–73.

    Article  PubMed  Google Scholar 

  67. Wong M, Isa SH, Zahiah M, Azmi KN. Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma. World J Surg. 2007;31:586–92.

    Article  PubMed  CAS  Google Scholar 

  68. Gress FG, Barawi M, Kim D, Grendell JH. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest Endosc. 2002;55:594–7.

    Article  PubMed  Google Scholar 

  69. Zografos GN, Stathopoulou A, Mitropapas G, et al. Preoperative imaging and localization of small sized insulinoma with EUS-guided fine needle tattooing: a case report. Hormones. 2005;4:111–6.

    PubMed  Google Scholar 

  70. Newman NA, Lennon AM, Edil BH, et al. Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal pancreatectomy. Surgery. 2010;148:371–7.

    Article  PubMed  Google Scholar 

  71. Law JK, Singh VK, Khashab MA, et al. Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery. Surg Endosc. 2013;27:3921–6.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Saftoiu A, Dietrich CF, Vilmann P. Contrast-enhanced harmonic endoscopic ultrasound. Endoscopy. 2012;44:612–7.

    Article  PubMed  CAS  Google Scholar 

  73. Fusaroli P, Spada A, Mancino MG, Caletti G. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol. 2010;8:629–34. e1–2.

    Article  PubMed  Google Scholar 

  74. Kitano M, Kudo M, Yamao K, et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol. 2012;107:303–10.

    Article  PubMed  Google Scholar 

  75. Itokawa F, Itoi T, Sofuni A, et al. EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. J Gastroenterol. 2011;46:843–53.

    Article  PubMed  Google Scholar 

  76. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139:1172–80.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Yale Center for Pancreatic Disease, Yale University School of Medicine, LMP 1080, 15 York Street, New Haven, CT, 06510-3221, USA

    Tarun Rustagi M.D. & James J. Farrell M.D.

  2. Section of Digestive Diseases, Yale University School of Medicine, LMP 1080, 15 York Street, New Haven, CT, 06510-3221, USA

    Tarun Rustagi M.D. & James J. Farrell M.D.

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  1. Tarun Rustagi M.D.
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  2. James J. Farrell M.D.
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Correspondence to James J. Farrell M.D. .

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  1. VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

    Joseph R. Pisegna

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Rustagi, T., Farrell, J.J. (2015). Endoscopic Approaches for Diagnosis of Pancreatic Neuroendocrine Tumors. In: Pisegna, J. (eds) Management of Pancreatic Neuroendocrine Tumors. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1798-3_7

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  • DOI: https://doi.org/10.1007/978-1-4939-1798-3_7

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