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Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice

BACKGROUND: In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (PanNETs) have a high prevalence and represent the main cause of death. This study aimed to assess the diagnostic accuracy of the currently used conventional pancreatic imaging techniques and the added value...

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Autores principales: van Beek, Dirk-Jan, Pieterman, Carolina R. C., Wessels, Frank J., van de Ven, Annenienke C., de Herder, Wouter W., Dekkers, Olaf M., Zandee, Wouter T., Drent, Madeleine L., Bisschop, Peter H., Havekes, Bas, Borel Rinkes, Inne H. M., Vriens, Menno R., Valk, Gerlof D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9585192/
https://www.ncbi.nlm.nih.gov/pubmed/36277719
http://dx.doi.org/10.3389/fendo.2022.926491
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author van Beek, Dirk-Jan
Pieterman, Carolina R. C.
Wessels, Frank J.
van de Ven, Annenienke C.
de Herder, Wouter W.
Dekkers, Olaf M.
Zandee, Wouter T.
Drent, Madeleine L.
Bisschop, Peter H.
Havekes, Bas
Borel Rinkes, Inne H. M.
Vriens, Menno R.
Valk, Gerlof D.
author_facet van Beek, Dirk-Jan
Pieterman, Carolina R. C.
Wessels, Frank J.
van de Ven, Annenienke C.
de Herder, Wouter W.
Dekkers, Olaf M.
Zandee, Wouter T.
Drent, Madeleine L.
Bisschop, Peter H.
Havekes, Bas
Borel Rinkes, Inne H. M.
Vriens, Menno R.
Valk, Gerlof D.
author_sort van Beek, Dirk-Jan
collection PubMed
description BACKGROUND: In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (PanNETs) have a high prevalence and represent the main cause of death. This study aimed to assess the diagnostic accuracy of the currently used conventional pancreatic imaging techniques and the added value of fine needle aspirations (FNAs). METHODS: Patients who had at least one imaging study were included from the population-based MEN1 database of the DutchMEN Study Group from 1990 to 2017. Magnetic resonance imaging (MRI), computed tomography (CT), endoscopic ultrasonography (EUS), FNA, and surgical resection specimens were obtained. The first MRI, CT, or EUS was considered as the index test. For a comparison of the diagnostic accuracy of MRI versus CT, patients with their index test taken between 2010 and 2017 were included. The reference standard consisted of surgical histopathology or radiological follow-up. RESULTS: A total of 413 patients (92.8% of the database) underwent 3,477 imaging studies. The number of imaging studies per patient increased, and a preference for MRI was observed in the last decade. Overall diagnostic accuracy was good with a positive (PPV) and negative predictive value (NPV) of 88.9% (95% confidence interval, 76.0–95.6) and 92.8% (89.4–95.1), respectively, for PanNET in the pancreatic head and 92.0% (85.3–96.0) and 85.3% (80.5–89.1), respectively, in the body/tail. For MRI, PPV and NPV for pancreatic head tumors were 100% (76.1–100) and 87.1% (76.3–93.6) and for CT, 60.0% (22.9–88.4) and 70.4% (51.3–84.3), respectively. For body/tail tumors, PPV and NPV were 91.3% (72.0–98.8) and 87.0% (75.3–93.9), respectively, for MRI and 100% (74.9–100) and 77.8% (54.3–91.5), respectively, for CT. Pathology confirmed a PanNET in 106 out of 110 (96.4%) resection specimens. FNA was performed on 34 lesions in 33 patients and was considered PanNET in 24 [all confirmed PanNET by histology (10) or follow-up (14)], normal/cyst/unrepresentative in 6 (all confirmed PanNET by follow-up), and adenocarcinoma in 4 (2 confirmed and 2 PanNET). Three patients, all older than 60 years, had a final diagnosis of pancreatic adenocarcinoma. CONCLUSION: As the accuracy for diagnosing MEN1-related PanNET of MRI was higher than that of CT, MRI should be the preferred (non-invasive) imaging modality for PanNET screening/surveillance. The high diagnostic accuracy of pancreatic imaging and the sporadic occurrence of pancreatic adenocarcinoma question the need for routine (EUS-guided) FNA.
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spelling pubmed-95851922022-10-22 Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice van Beek, Dirk-Jan Pieterman, Carolina R. C. Wessels, Frank J. van de Ven, Annenienke C. de Herder, Wouter W. Dekkers, Olaf M. Zandee, Wouter T. Drent, Madeleine L. Bisschop, Peter H. Havekes, Bas Borel Rinkes, Inne H. M. Vriens, Menno R. Valk, Gerlof D. Front Endocrinol (Lausanne) Endocrinology BACKGROUND: In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (PanNETs) have a high prevalence and represent the main cause of death. This study aimed to assess the diagnostic accuracy of the currently used conventional pancreatic imaging techniques and the added value of fine needle aspirations (FNAs). METHODS: Patients who had at least one imaging study were included from the population-based MEN1 database of the DutchMEN Study Group from 1990 to 2017. Magnetic resonance imaging (MRI), computed tomography (CT), endoscopic ultrasonography (EUS), FNA, and surgical resection specimens were obtained. The first MRI, CT, or EUS was considered as the index test. For a comparison of the diagnostic accuracy of MRI versus CT, patients with their index test taken between 2010 and 2017 were included. The reference standard consisted of surgical histopathology or radiological follow-up. RESULTS: A total of 413 patients (92.8% of the database) underwent 3,477 imaging studies. The number of imaging studies per patient increased, and a preference for MRI was observed in the last decade. Overall diagnostic accuracy was good with a positive (PPV) and negative predictive value (NPV) of 88.9% (95% confidence interval, 76.0–95.6) and 92.8% (89.4–95.1), respectively, for PanNET in the pancreatic head and 92.0% (85.3–96.0) and 85.3% (80.5–89.1), respectively, in the body/tail. For MRI, PPV and NPV for pancreatic head tumors were 100% (76.1–100) and 87.1% (76.3–93.6) and for CT, 60.0% (22.9–88.4) and 70.4% (51.3–84.3), respectively. For body/tail tumors, PPV and NPV were 91.3% (72.0–98.8) and 87.0% (75.3–93.9), respectively, for MRI and 100% (74.9–100) and 77.8% (54.3–91.5), respectively, for CT. Pathology confirmed a PanNET in 106 out of 110 (96.4%) resection specimens. FNA was performed on 34 lesions in 33 patients and was considered PanNET in 24 [all confirmed PanNET by histology (10) or follow-up (14)], normal/cyst/unrepresentative in 6 (all confirmed PanNET by follow-up), and adenocarcinoma in 4 (2 confirmed and 2 PanNET). Three patients, all older than 60 years, had a final diagnosis of pancreatic adenocarcinoma. CONCLUSION: As the accuracy for diagnosing MEN1-related PanNET of MRI was higher than that of CT, MRI should be the preferred (non-invasive) imaging modality for PanNET screening/surveillance. The high diagnostic accuracy of pancreatic imaging and the sporadic occurrence of pancreatic adenocarcinoma question the need for routine (EUS-guided) FNA. Frontiers Media S.A. 2022-10-07 /pmc/articles/PMC9585192/ /pubmed/36277719 http://dx.doi.org/10.3389/fendo.2022.926491 Text en Copyright © 2022 van Beek, Pieterman, Wessels, van de Ven, de Herder, Dekkers, Zandee, Drent, Bisschop, Havekes, Borel Rinkes, Vriens and Valk https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
van Beek, Dirk-Jan
Pieterman, Carolina R. C.
Wessels, Frank J.
van de Ven, Annenienke C.
de Herder, Wouter W.
Dekkers, Olaf M.
Zandee, Wouter T.
Drent, Madeleine L.
Bisschop, Peter H.
Havekes, Bas
Borel Rinkes, Inne H. M.
Vriens, Menno R.
Valk, Gerlof D.
Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title_full Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title_fullStr Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title_full_unstemmed Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title_short Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
title_sort diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9585192/
https://www.ncbi.nlm.nih.gov/pubmed/36277719
http://dx.doi.org/10.3389/fendo.2022.926491
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