小的无功能胰腺神经内分泌肿瘤的管理：当前观点与争议
Management of Small Nonfunctioning Pancreatic Neuroendocrine Neoplasms: Current Opinion and Controversies.
作者信息
Paik Woo Hyun, Lee Kyong Joo
机构信息
Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea.
出版信息
J Clin Med. 2022 Dec 29;12(1):251. doi: 10.3390/jcm12010251.
The incidence of small and asymptomatic pancreatic neuroendocrine neoplasms (PNENs) has increased due to the widespread use of high-resolution diagnostic imaging in screening programs. Most PNENs are slow-growing indolent neoplasms. However, a local invasion or metastasis can sometimes occur with PNENs, leading to a poor prognosis. The management of small, nonfunctioning PNENs remains under debate. The National Comprehensive Cancer Network guidelines recommend observation in selected cases of small PNENs less than 2 cm. Pancreatic surgery remains a high-risk operation with a 28-30% morbidity and 1% mortality. Therefore, the decision on how to manage small PNENs is challenging. This review focuses on the management of small nonfunctioning PNENs. We also highlight the malignant potential of small PNENs according to tumor size, tumor grade, and tumor biomarker. Endoscopic-ultrasound-guided biopsy is recommended to evaluate the potential risk of malignancy. Furthermore, we discuss the current guidelines and future directions for the management of small PNENs.
由于在筛查项目中广泛使用高分辨率诊断成像，小的无症状胰腺神经内分泌肿瘤（PNENs）的发病率有所上升。大多数PNENs是生长缓慢的惰性肿瘤。然而，PNENs有时会发生局部侵犯或转移，导致预后不良。小的无功能PNENs的治疗仍存在争议。美国国立综合癌症网络指南建议，对于某些直径小于2 cm的小PNENs病例进行观察。胰腺手术仍然是一项高风险手术，发病率为28%-30%，死亡率为1%。因此，如何处理小PNENs的决策具有挑战性。本综述重点关注小的无功能PNENs的治疗。我们还根据肿瘤大小、肿瘤分级和肿瘤生物标志物强调了小PNENs的恶性潜能。建议采用内镜超声引导下活检来评估恶性潜能风险。此外，我们讨论了小PNENs治疗的当前指南和未来方向。
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