Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan.
Division of Endoscopy, Shizuoka Cancer Center, Japan.
Intern Med. 2023 Dec 15;62(24):3585-3590. doi: 10.2169/internalmedicine.1693-23. Epub 2023 Apr 21.
Objective Clinical practice guidelines in Japan recommend surgery for all nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs), regardless of their size or associated symptoms. Because pancreatic resection is highly invasive, follow-up for small NF-PNETs is often chosen in clinical practice. However, the natural history of NF-PNET remains poorly understood. We aimed to examine the natural history of pathologically confirmed NF-PNET. Methods This single-center retrospective case series investigated NF-PNETs that were pathologically diagnosed using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) at our hospital between 2014 and 2018. Patients who were followed up without treatment due to their general condition or their wish were included in the study. Patients' background characteristics, imaging findings, pathological findings, and long-term prognoses were investigated using medical records. Results Overall, 26 patients were diagnosed with NF-PNET by EUS-FNA during the observation period. Of these, 9 patients (3 men and 6 women; median age: 64 years old) were followed up without treatment. All of these patients were asymptomatic, and localization was noticed in 3 cases in the head, body, and tail (1 each), with a median size of 12 (range: 4-18) mm. Neuroendocrine tumor (Grade 1 [G1]) was pathologically diagnosed in all patients with EUS-FNA. The median observation period was 63 (range: 26-90) months. Tumor growth and distant metastasis were not observed in any of the nine patients who remained asymptomatic. Conclusion Follow-up is a feasible option for asymptomatic NF-PNET ≤20 mm in size with a pathological grade of G1.
目的 日本的临床实践指南建议对所有无功能性胰腺神经内分泌肿瘤（NF-PNET）进行手术治疗，无论肿瘤大小或相关症状如何。由于胰腺切除术具有高度侵袭性，因此在临床实践中通常选择对小 NF-PNET 进行随访。然而，NF-PNET 的自然病程仍知之甚少。我们旨在研究经病理证实的 NF-PNET 的自然病程。
方法 本单中心回顾性病例系列研究纳入了 2014 年至 2018 年期间在我院经内镜超声引导下细针抽吸活检（EUS-FNA）病理诊断为 NF-PNET 的患者。由于一般情况或患者意愿而未接受治疗并进行随访的患者纳入本研究。通过病历调查患者的背景特征、影像学表现、病理发现和长期预后。
结果 在观察期间，共有 26 例患者通过 EUS-FNA 诊断为 NF-PNET。其中，9 例（3 名男性和 6 名女性；中位年龄：64 岁）患者未接受治疗而进行随访。所有这些患者均无症状，3 例患者在头部、体部和尾部（各 1 例）发现肿瘤定位，肿瘤直径中位数为 12（范围：4-18）mm。所有患者经 EUS-FNA 均病理诊断为神经内分泌肿瘤（G1 级）。中位观察期为 63（范围：26-90）个月。在 9 例无症状的患者中，均未观察到肿瘤生长和远处转移。
结论 对于直径≤20mm、病理分级为 G1 的无症状 NF-PNET，随访是一种可行的选择。
