Cystic pancreatic neuroendocrine tumors: Outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up

Wiriyaporn Ridtitid, Houssam Halawi, John DeWitt, Stuart Sherman, Julia Leblanc, Lee McHenry, Gregory A. Coté, Mohammad A. Al-Haddad

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and study aims: The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and management of cystic pancreatic neuroendocrine tumors (PNETs) is unclear. We aimed to compare clinical/endosonographic characteristics of cystic with solid PNETs, determine diagnostic accuracy of preoperative EUS-FNA, and evaluate recurrence rates after resection. Patients and methods: All patients with cystic or solid PNET confirmed by EUS-FNA between 2000 and 2014 were identified. A matched case-control study compared 50 consecutive patients with cystic PNETs with 50 consecutive patients with solid PNETs, matched by gender and age at diagnosis of index cystic PNET. We compared clinical/endosonographic characteristics, assessed diagnostic accuracy of preoperative EUS-FNA for identifying malignancy, and analyzed tumor-free survival of patients with cystic and solid PNETs. Results: Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1mm, P=0.05), more frequently nonfunctional (96% vs. 80%, P=0.03), and less frequently associated with multiple endocrine neoplasia type 1 (10% vs. 28%, P=0.04). With surgical pathology as reference standard, EUS-FNA accuracies for malignancy of cystic and solid PNETs were 89.3% and 90%, respectively; cystic PNETs were less associated with metastatic adenopathy (22% vs. 42%, P=0.03) and liver metastasis (0% vs. 26%, P<0.001). Cystic fluid analysis (n=13), showed benign cystic PNETs had low carcinoembryonic antigen (CEA), Ki-67≤2%, and no loss of heterozygosity. Patients with cystic and solid PNETs had similar recurrence risk up to 5 years after complete resection. Conclusions: Cystic PNETs have distinct clinical and EUS characteristics, but were associated with less aggressive biological behavior compared with solid PNETs. EUS-FNA is accurate for determining malignant potential on preoperative evaluation. Despite complete resection, recurrence is observed up to 5 years following surgery.

Original languageEnglish
Pages (from-to)617-625
Number of pages9
JournalEndoscopy
Volume47
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Endosonography
Neuroendocrine Tumors
Fine Needle Biopsy
Recurrence
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Multiple Endocrine Neoplasia Type 1
Neoplasms
Surgical Pathology
Loss of Heterozygosity
Carcinoembryonic Antigen

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cystic pancreatic neuroendocrine tumors : Outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up. / Ridtitid, Wiriyaporn; Halawi, Houssam; DeWitt, John; Sherman, Stuart; Leblanc, Julia; McHenry, Lee; Coté, Gregory A.; Al-Haddad, Mohammad A.

In: Endoscopy, Vol. 47, No. 7, 01.07.2015, p. 617-625.

Research output: Contribution to journalArticle

Ridtitid, Wiriyaporn ; Halawi, Houssam ; DeWitt, John ; Sherman, Stuart ; Leblanc, Julia ; McHenry, Lee ; Coté, Gregory A. ; Al-Haddad, Mohammad A. / Cystic pancreatic neuroendocrine tumors : Outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up. In: Endoscopy. 2015 ; Vol. 47, No. 7. pp. 617-625.
@article{755043116c544366afe9a6ff2567a39c,
title = "Cystic pancreatic neuroendocrine tumors: Outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up",
abstract = "Background and study aims: The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and management of cystic pancreatic neuroendocrine tumors (PNETs) is unclear. We aimed to compare clinical/endosonographic characteristics of cystic with solid PNETs, determine diagnostic accuracy of preoperative EUS-FNA, and evaluate recurrence rates after resection. Patients and methods: All patients with cystic or solid PNET confirmed by EUS-FNA between 2000 and 2014 were identified. A matched case-control study compared 50 consecutive patients with cystic PNETs with 50 consecutive patients with solid PNETs, matched by gender and age at diagnosis of index cystic PNET. We compared clinical/endosonographic characteristics, assessed diagnostic accuracy of preoperative EUS-FNA for identifying malignancy, and analyzed tumor-free survival of patients with cystic and solid PNETs. Results: Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1mm, P=0.05), more frequently nonfunctional (96{\%} vs. 80{\%}, P=0.03), and less frequently associated with multiple endocrine neoplasia type 1 (10{\%} vs. 28{\%}, P=0.04). With surgical pathology as reference standard, EUS-FNA accuracies for malignancy of cystic and solid PNETs were 89.3{\%} and 90{\%}, respectively; cystic PNETs were less associated with metastatic adenopathy (22{\%} vs. 42{\%}, P=0.03) and liver metastasis (0{\%} vs. 26{\%}, P<0.001). Cystic fluid analysis (n=13), showed benign cystic PNETs had low carcinoembryonic antigen (CEA), Ki-67≤2{\%}, and no loss of heterozygosity. Patients with cystic and solid PNETs had similar recurrence risk up to 5 years after complete resection. Conclusions: Cystic PNETs have distinct clinical and EUS characteristics, but were associated with less aggressive biological behavior compared with solid PNETs. EUS-FNA is accurate for determining malignant potential on preoperative evaluation. Despite complete resection, recurrence is observed up to 5 years following surgery.",
author = "Wiriyaporn Ridtitid and Houssam Halawi and John DeWitt and Stuart Sherman and Julia Leblanc and Lee McHenry and Cot{\'e}, {Gregory A.} and Al-Haddad, {Mohammad A.}",
year = "2015",
month = "7",
day = "1",
doi = "10.1055/s-0034-1391712",
language = "English",
volume = "47",
pages = "617--625",
journal = "Endoscopy",
issn = "0013-726X",
publisher = "Georg Thieme Verlag",
number = "7",

}

TY - JOUR

T1 - Cystic pancreatic neuroendocrine tumors

T2 - Outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up

AU - Ridtitid, Wiriyaporn

AU - Halawi, Houssam

AU - DeWitt, John

AU - Sherman, Stuart

AU - Leblanc, Julia

AU - McHenry, Lee

AU - Coté, Gregory A.

AU - Al-Haddad, Mohammad A.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background and study aims: The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and management of cystic pancreatic neuroendocrine tumors (PNETs) is unclear. We aimed to compare clinical/endosonographic characteristics of cystic with solid PNETs, determine diagnostic accuracy of preoperative EUS-FNA, and evaluate recurrence rates after resection. Patients and methods: All patients with cystic or solid PNET confirmed by EUS-FNA between 2000 and 2014 were identified. A matched case-control study compared 50 consecutive patients with cystic PNETs with 50 consecutive patients with solid PNETs, matched by gender and age at diagnosis of index cystic PNET. We compared clinical/endosonographic characteristics, assessed diagnostic accuracy of preoperative EUS-FNA for identifying malignancy, and analyzed tumor-free survival of patients with cystic and solid PNETs. Results: Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1mm, P=0.05), more frequently nonfunctional (96% vs. 80%, P=0.03), and less frequently associated with multiple endocrine neoplasia type 1 (10% vs. 28%, P=0.04). With surgical pathology as reference standard, EUS-FNA accuracies for malignancy of cystic and solid PNETs were 89.3% and 90%, respectively; cystic PNETs were less associated with metastatic adenopathy (22% vs. 42%, P=0.03) and liver metastasis (0% vs. 26%, P<0.001). Cystic fluid analysis (n=13), showed benign cystic PNETs had low carcinoembryonic antigen (CEA), Ki-67≤2%, and no loss of heterozygosity. Patients with cystic and solid PNETs had similar recurrence risk up to 5 years after complete resection. Conclusions: Cystic PNETs have distinct clinical and EUS characteristics, but were associated with less aggressive biological behavior compared with solid PNETs. EUS-FNA is accurate for determining malignant potential on preoperative evaluation. Despite complete resection, recurrence is observed up to 5 years following surgery.

AB - Background and study aims: The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and management of cystic pancreatic neuroendocrine tumors (PNETs) is unclear. We aimed to compare clinical/endosonographic characteristics of cystic with solid PNETs, determine diagnostic accuracy of preoperative EUS-FNA, and evaluate recurrence rates after resection. Patients and methods: All patients with cystic or solid PNET confirmed by EUS-FNA between 2000 and 2014 were identified. A matched case-control study compared 50 consecutive patients with cystic PNETs with 50 consecutive patients with solid PNETs, matched by gender and age at diagnosis of index cystic PNET. We compared clinical/endosonographic characteristics, assessed diagnostic accuracy of preoperative EUS-FNA for identifying malignancy, and analyzed tumor-free survival of patients with cystic and solid PNETs. Results: Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1mm, P=0.05), more frequently nonfunctional (96% vs. 80%, P=0.03), and less frequently associated with multiple endocrine neoplasia type 1 (10% vs. 28%, P=0.04). With surgical pathology as reference standard, EUS-FNA accuracies for malignancy of cystic and solid PNETs were 89.3% and 90%, respectively; cystic PNETs were less associated with metastatic adenopathy (22% vs. 42%, P=0.03) and liver metastasis (0% vs. 26%, P<0.001). Cystic fluid analysis (n=13), showed benign cystic PNETs had low carcinoembryonic antigen (CEA), Ki-67≤2%, and no loss of heterozygosity. Patients with cystic and solid PNETs had similar recurrence risk up to 5 years after complete resection. Conclusions: Cystic PNETs have distinct clinical and EUS characteristics, but were associated with less aggressive biological behavior compared with solid PNETs. EUS-FNA is accurate for determining malignant potential on preoperative evaluation. Despite complete resection, recurrence is observed up to 5 years following surgery.

UR - http://www.scopus.com/inward/record.url?scp=84933277798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84933277798&partnerID=8YFLogxK

U2 - 10.1055/s-0034-1391712

DO - 10.1055/s-0034-1391712

M3 - Article

C2 - 25763832

AN - SCOPUS:84933277798

VL - 47

SP - 617

EP - 625

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 7

ER -