Gupta Nikhil, Kankotia Ravi, Sahakian Ara, Jayaram Preeth, Shindel Alex, Dong Elizabeth, Korc Paul, Eloubeidi Mohamad, Buxbaum James
Division of Gastroenterology, Department of Medicine, Kaiser Permanente Los Angeles, Los Angeles.
Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, CA.
Pancreas. 2019 Jan;48(1):66-69. doi: 10.1097/MPA.0000000000001200.
Distinguishing neuroendocrine tumors (NETs) and other pancreas lesions from adenocarcinomas via endoscopic ultrasound (EUS) requires additional tissue for special staining and processing. Our aim was to determine if main pancreatic duct (PD) diameter on EUS helps to differentiate NET and other unusual tumors from adenocarcinoma.
We evaluated 30 consecutive patients diagnosed with NET or other pancreas lesions by EUS with 90 matched patients who were found to have adenocarcinoma. Dilated PD was defined as greater than 3 mm. Multivariate logistic regression was used to evaluate associations between lesion type and PD diameter.
Among the 30 patients with NET/other pancreas lesions, 21 had NETs, 7 had metastases, and 2 had lymphomas. A dilated PD was demonstrated in only 3.3% of pancreatic NET/other lesions but present in 88.9% of cases of primary adenocarcinoma (P < 0.01). In multivariate analysis, a normal PD diameter and absence of clinical symptoms strongly predicted the presence of pancreatic NET/other versus adenocarcinoma (P < 0.01).
The absence of PD dilation upstream of the lesion suggests NET or other lesions rather than adenocarcinoma. This finding should prompt endosonographers to obtain additional tissue at the time of EUS to send for special studies.
通过内镜超声（EUS）将神经内分泌肿瘤（NETs）及其他胰腺病变与腺癌区分开来，需要额外的组织进行特殊染色和处理。我们的目的是确定EUS上主胰管（PD）直径是否有助于将NET和其他不常见肿瘤与腺癌区分开来。
我们评估了30例经EUS诊断为NET或其他胰腺病变的连续患者，并与90例被发现患有腺癌的匹配患者进行对照。扩张的PD定义为大于3mm。采用多因素逻辑回归分析评估病变类型与PD直径之间的关联。
在30例NET/其他胰腺病变患者中，21例为NETs，7例为转移瘤，2例为淋巴瘤。胰腺NET/其他病变中仅3.3%显示有扩张的PD，而原发性腺癌病例中有88.9%存在扩张的PD（P<0.01）。在多因素分析中，正常的PD直径和无临床症状强烈提示存在胰腺NET/其他病变而非腺癌（P<0.01）。
病变上游无PD扩张提示为NET或其他病变而非腺癌。这一发现应促使内镜超声检查者在EUS检查时获取额外组织送检进行特殊研究。
