Fujimori Nao, Osoegawa Takashi, Lee Lingaku, Tachibana Yuichi, Aso Akira, Kubo Hiroaki, Kawabe Ken, Igarashi Hisato, Nakamura Kazuhiko, Oda Yoshinao, Ito Tetsuhide
a Department of Medicine and Bioregulatory Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan .
b Department of Gastroenterology , Clinical Research Institute, National Hospital Organization Kyushu Medical Center , Fukuoka , Japan , and.
Scand J Gastroenterol. 2016;51(2):245-52. doi: 10.3109/00365521.2015.1083050. Epub 2015 Sep 11.
Pancreatic neuroendocrine tumors (pNETs) are histologically categorized according to the WHO 2010 classification by their mitotic index or Ki-67 index as G1, G2, or G3. The present study examined the efficacy of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis and grading of pNET.
We retrospectively reviewed 61 pNETs in 51 patients who underwent EUS between January 2007 and June 2014. All lesions were pathologically diagnosed by surgical resection or EUS-FNA. We evaluated the detection rates of EUS for pNET and sensitivity of EUS-FNA, and compared the Ki-67 index between EUS-FNA samples and surgical specimens. EUS findings were compared between G1 and G2/G3 tumors.
EUS showed significantly higher sensitivity (96.7%) for identifying pNET than CT (85.2%), MRI (70.2%), and ultrasonography (75.5%). The sensitivity of EUS-FNA for the diagnosis of pNET was 89.2%. The concordance rate of WHO classification between EUS-FNA and surgical specimens was 69.2% (9/13). The concordance rate was relatively high (87.5%, 5/6) in tumors <20 mm but lower (57.1%; 4/7) in tumors ≥20 mm. Regarding EUS findings, G2/G3 tumors were more likely to be large (>20 mm), heterogeneous, and have main pancreatic duct (MPD) obstruction than G1 tumors. Multivariate analysis showed large diameter and MPD obstruction were significantly associated with G2/G3 tumors.
EUS and EUS-FNA are highly sensitive and accurate diagnostic methods for pNET. Characteristic EUS findings such as large tumor size and MPD obstruction are suggestive of G2/G3 tumors and would be helpful for grading pNETs.
胰腺神经内分泌肿瘤（pNETs）根据2010年世界卫生组织分类，依据其有丝分裂指数或Ki-67指数在组织学上分为G1、G2或G3级。本研究探讨了内镜超声（EUS）及EUS引导下细针穿刺活检（EUS-FNA）在pNET诊断及分级中的效能。
我们回顾性分析了2007年1月至2014年6月期间接受EUS检查的51例患者的61个pNETs。所有病变均通过手术切除或EUS-FNA进行病理诊断。我们评估了EUS对pNET的检出率及EUS-FNA的敏感性，并比较了EUS-FNA样本与手术标本之间的Ki-67指数。比较了G1和G2/G3肿瘤的EUS表现。
EUS在识别pNET方面的敏感性（96.7%）显著高于CT（85.2%）、MRI（70.2%）和超声（75.5%）。EUS-FNA诊断pNET的敏感性为89.2%。EUS-FNA与手术标本之间WHO分类的一致性率为69.2%（9/13）。肿瘤<20mm时一致性率相对较高（87.5%，5/6），而肿瘤≥20mm时较低（57.1%；4/7）。关于EUS表现，与G1肿瘤相比，G2/G3肿瘤更易表现为体积大（>20mm）、不均匀且伴有主胰管（MPD）梗阻。多因素分析显示，肿瘤直径大及MPD梗阻与G2/G3肿瘤显著相关。
EUS及EUS-FNA是pNET高度敏感且准确的诊断方法。肿瘤体积大及MPD梗阻等特征性EUS表现提示为G2/G3肿瘤，有助于pNET的分级。
