ECE2022 Oral Communications Young Investigator Awards (12 abstracts)
Diagnosing pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 in daily practice
Carolina Pieterman 1 , Dirk-Jan Van Beek 2 , Frank J Wessels 3 , Annenienke C van de Ven 4 , Wouter W de Herder 5 , Olaf M Dekkers 6 , Wouter T Zandee 7 , Madeline L Drent 8 , Peter H Bisschop 9 , Bas Havekes 10 , Inne HM Borel Rinkes 2 , Menno R Vriens 2 & Gerlof D Valk 1
1University Medical Center Utrecht, Endocrine Oncology, Utrecht, Netherlands; 2University Medical Center Utrecht, Endocrine Surgical Oncology, Utrecht, Netherlands; 3UMC Utrecht, Radiology, Utrecht, Netherlands; 4Radboud University Medical Center, Endocrinology, Nijmegen, Netherlands; 5Erasmus MC, Internal Medicine, Rotterdam, Netherlands; 6Leiden University Medical Center (LUMC), Endocrinology and Metabolism and Clinical Epidemiology, Leiden, Netherlands; 7University Medical Center Groningen, Endocrinology, Groningen, Netherlands; 8Amsterdam UMC, locatie VUmc, Internal Medicine, Section of Endocrinology, Amsterdam, Netherlands; 9Amsterdam UMC, locatie AMC, Endocrinology and Metabolism, Amsterdam, Netherlands; 10Maastricht UMC, Internal Medicine, Division of Endocrinology, Maastricht, Netherlands
Background: Pancreatic Neuroendocrine Tumors (PanNETs) are highly prevalent in Multiple Endocrine Neoplasia type 1 (MEN1) and one of the main causes of mortality. Conventional imaging is the mainstay of PanNET screening/surveillance in MEN1. This study aims to assess the diagnostic accuracy of conventional pancreatic imaging studies and to determine the added value of pancreatic fine needle aspirations (FNA) for the diagnosis of MEN1-related PanNETs.
Methods: Patients were included from the population-based MEN1 database of the DutchMEN Study Group from 1990–2017 (n=445). Magnetic resonance imaging (MRI), computed tomography (CT), endoscopic ultrasound (EUS), FNA, and surgical resection specimens were obtained. For diagnostic accuracy assessment patients with a PanNET diagnosis >1990 were included if both index and reference test were available. To assess diagnostic accuracy, the first imaging (CT, MRI or EUS) of the pancreatic head and the first imaging of the pancreatic body/tail were considered the index test. For specific comparison of diagnostic accuracy between MRI and CT in the modern era, the first MRI or CT between 2010 and 2017 was the index text. The reference standard was a composite of surgical histopathology and if histopathology was unavailable radiological follow-up.
Results: 413 patients underwent 3477 imaging studies. Median radiological follow-up was 8.4 yrs. Time trends show an increasing number of scans/patient, and a preference for MRI in the last decade. Overall diagnostic accuracy of the combined conventional imaging was good with a positive (PPV) and negative predictive value (NPV) of 88.9% (76.0-95.6) and 92.8% (89.4-95.1) for PanNET located in the pancreatic head and 92% (85.3-96.0) and 85.3% (80.5-89.1) in the body/tail. For comparison of MRI vs CT, PPV and NPV for tumors located in the head were 100%(76.0-100) and 87.1%(76.3-93.6) (MRI) vs 60%(22.9-88.4) and 70.4%(51.3-84.3) (CT). PPV and NPV for tumors located in the body/tail were 91.3%(72.0-98.8) and 87.0%(75.3-93.9) (MRI) vs 100%(74.9-100) and 77.8%(54.3-91.5) (CT). FNA was performed of 34 lesions in 33 patients. FNA diagnosis was 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, 2 PanNET).
Conclusion: Diagnostic accuracy for the diagnosis of PanNET was higher for MRI compared to CT and MRI should be the preferred (non-invasive) imaging modality for PanNET screening/surveillance in MEN1. 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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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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