Varas Lorenzo M J, Miquel Collell J M, Maluenda Colomer M D, Boix Valverde J, Armengol Miró J R
Units of Echoendoscopy and Endoscopy, Centro Médico Teknon, Universidad Autónoma de Barcelona, Spain.
Rev Esp Enferm Dig. 2006 Nov;98(11):828-36. doi: 10.4321/s1130-01082006001100004.
Almost 30% of gastroenteropancreatic neuroendocrine tumors (GEPET) escape preoperative identification using standard imaging techniques. The goal of this retrospective study is to present our cumulative experience in the assessment of GEPET by preoperative endoscopic ultrasonography (EUS), and to compare it with a literature review.
Thirty-seven patients with suspected specific hormonal syndromes were sequentially examined with US, CT, MRI, angiography, OctreoScan, and radial and sectorial EUS. Sixteen were males (43%) and 21 were females (57%), with a mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27 had 19 endocrine tumors in the pancreas and 14 tumors in their gastrointestinal tract. No tumors were demonstrated in 10 patients, hence they were used as a control group. Of all 37 patients, 24 were operated on or had histological samples collected, with the presence of 26 GEPET (10 carcinoids) being confirmed in 22 patients.
EUS sensitivity and diagnostic accuracy were 81% and 78%. Specificity was 80%. All these values were similar to the mean values obtained from the literature review. Three pancreatic rumors smaller than or equal to 1 cm (insulinomas) were detected, which had escaped diagnosis with previous US, CT, and MRI studies. An echoendoscopic examination of the pancreas could not be completed in two cases (5%), a pancreas carcinoid and an already gastrectomized double pancreatic gastrinoma.
EUS is a good preoperative technique for GEPET detection, and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or HCT has been posited for tumor diagnosis and localization before surgery.
近30%的胃肠胰神经内分泌肿瘤（GEPET）无法通过标准成像技术在术前被识别。这项回顾性研究的目的是介绍我们在术前通过内镜超声检查（EUS）评估GEPET的累积经验，并将其与文献综述进行比较。
对37例疑似特定激素综合征的患者依次进行超声、CT、MRI、血管造影、奥曲肽扫描以及径向和扇形EUS检查。其中男性16例（43%），女性21例（57%），平均年龄61岁（范围：40 - 84岁）。37例患者中，27例有胰腺内分泌肿瘤19个，胃肠道肿瘤14个。10例患者未发现肿瘤，因此用作对照组。37例患者中，24例接受了手术或采集了组织样本，22例患者中确诊有26个GEPET（10个类癌）。
EUS的敏感性和诊断准确性分别为81%和78%，特异性为80%。所有这些值与文献综述得出的平均值相似。检测到3个直径小于或等于1 cm的胰腺肿瘤（胰岛素瘤），这些肿瘤在之前的超声、CT和MRI检查中均未被诊断出来。有2例（5%）无法完成胰腺的超声内镜检查，分别为1例胰腺类癌和1例已行胃切除术的双发性胰腺胃泌素瘤。
EUS是一种用于检测GEPET的良好术前技术，在评估小肿瘤方面可能优于其他成像技术。在超声或HCT之后将EUS作为主要检查手段，对于术前肿瘤诊断和定位具有一定作用。
