Furnari Manuele, Buda Andrea, Delconte Gabriele, Citterio Davide, Voiosu Theodor, Ballardini Giovanni, Cavallaro Flaminia, Savarino Edoardo, Mazzaferro Vincenzo, Meroni Emanuele
Department of Internal Medicine, Gastroenterology Unit, IRCCS, University of Genoa, Italy.
Gastroenterology Unit, Santa Maria Del Parato Hospital, Feltre, Italy.
J Gastrointestin Liver Dis. 2017 Jun;26(2):151-156. doi: 10.15403/jgld.2014.1121.262.wce.
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive.
Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.
Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.
Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.
神经内分泌肿瘤（NETs）是一组病因不明的异质性肿瘤，可表现为功能性或无功能性特征。原发性肿瘤定位通常需要综合成像检查。欧洲神经内分泌肿瘤学会（ENETS）指南提出，如果怀疑为肠道起源，无线胶囊内镜检查（WCE）可作为NETs的一种可能的诊断工具。然而，其对治疗管理的影响仍存在争议。我们旨在评估当一线检查结果不明确时，WCE在检测出现肝脏NET转移的患者肠道原发性肿瘤中的诊断价值。
在一家获得ENETS认证的三级医疗中心，对24例经肝活检组织学诊断为转移性NET且一线检查未发现原发性病变证据的患者进行前瞻性研究。在进行探索性剖腹手术和术中超声检查之前进行无线胶囊内镜检查。将WCE的诊断价值与手术探查结果进行比较。
16名受试者接受了手术；11/16的WCE检查结果为阳性，发现了16个隆起性病变。迷你剖腹手术在11/16例患者中发现了13个NETs（9个位于小肠，3个位于胰腺，1个位于胆管）。9例患者的WCE与剖腹手术结果一致（敏感性=75%；特异性=37.5%；阳性预测值=55%；阴性预测值=60%）。按病变评估的一致性产生了相似的结果（敏感性=70%；特异性=25%；阳性预测值=44%；阴性预测值=50%）。未记录到胶囊滞留情况。
对于胃肠胰NET患者，无线胶囊内镜检查不适合作为二线检查。在转诊中心的情况下，当传统检查对原发部位的诊断不明确时，它可能会提供额外信息。
