Indiana University School of Medicine, Indianapolis, Indiana, USA.
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Endoscopy. 2015 Jul;47(7):617-25. doi: 10.1055/s-0034-1391712. Epub 2015 Mar 12.
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.
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.
Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1 mm, 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.
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.
内镜超声引导下细针抽吸术（EUS-FNA）在囊性胰腺神经内分泌肿瘤（PNET）的诊断和治疗中的作用尚不清楚。我们旨在比较囊性和实性 PNET 的临床/内镜超声特征，确定术前 EUS-FNA 的诊断准确性，并评估切除后的复发率。
在 2000 年至 2014 年间，通过 EUS-FNA 确诊为囊性或实性 PNET 的所有患者均被纳入研究。一项匹配的病例对照研究比较了 50 例连续的囊性 PNET 患者和 50 例连续的实性 PNET 患者，通过索引性囊性 PNET 的性别和诊断时的年龄进行匹配。我们比较了临床/内镜超声特征，评估了术前 EUS-FNA 对恶性肿瘤的诊断准确性，并分析了囊性和实性 PNET 患者的无瘤生存情况。
囊性 PNET 比实性 PNET 更大（平均 26.8 毫米比 20.1 毫米，P=0.05），更常为无功能性（96%比 80%，P=0.03），且与多发性内分泌肿瘤 1 型（MEN1）的相关性较低（10%比 28%，P=0.04）。以手术病理为参考标准，囊性和实性 PNET 的 EUS-FNA 恶性肿瘤的准确性分别为 89.3%和 90%；囊性 PNET 较少伴转移性淋巴结病（22%比 42%，P=0.03）和肝转移（0%比 26%，P<0.001）。囊性液分析（n=13）显示良性囊性 PNET 的癌胚抗原（CEA）较低、Ki-67≤2%，且无杂合性丢失。囊性和实性 PNET 患者在完全切除后 5 年内的复发风险相似。
囊性 PNET 具有独特的临床和 EUS 特征，但与实性 PNET 相比，其生物学行为的侵袭性较低。EUS-FNA 可准确确定术前评估的恶性潜能。尽管进行了完全切除，但在手术后 5 年内仍观察到复发。
