Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430, Indonesia.
Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
Clin J Gastroenterol. 2024 Aug;17(4):754-759. doi: 10.1007/s12328-024-01959-2. Epub 2024 Mar 27.
Pancreatic neuroendocrine tumors (PNETs) are considered rare pancreatic neoplasms, and it is a challenging disease entity due to its indolent behavior and is difficult to manage. Diagnostic challenge is usually found in the imaging-based approach, such as transabdominal ultrasound, abdominal CT scan, and abdominal MRI. Surgery is still the main key player in controlling the disease. The main problems in clinical practice are the early detection of small PNETs lesion and non-functional PNET (NF-PNET) cases. Most cases usually come with large tumor size or metastatic disease. Endoscopic ultrasound (EUS) has been well-known as the most sensitive tool for early detection of pancreatic malignancy. It has now also been developed for managing pancreatic cancer, such as tumor ablation therapy. We presented four variety of PNETs cases (one patient with non-functioning PNETs and three patients with functioning PNETs) who have been successfully treated with EUS-guided radiofrequency ablation (RFA) with good control of tumor growth during follow-up. One patient with a large-size insulinoma could have the tumor controlled gradually after several EUS-RFA sessions. No adverse events or major complications were observed during and after the EUS-RFA procedure. EUS has been shown as a promising tool not only for more accurate diagnosis but also for tumor growth control. However, it would need further comparison studies between EUS and surgical approaches to make a better treatment strategy.
胰腺神经内分泌肿瘤（PNETs）被认为是罕见的胰腺肿瘤，由于其惰性的行为，且难以管理，因此是一种具有挑战性的疾病实体。诊断方面的挑战通常出现在基于影像学的方法中，如经腹超声、腹部 CT 扫描和腹部 MRI。手术仍然是控制疾病的主要关键手段。临床上的主要问题是早期发现小的 PNET 病变和无功能性 PNET（NF-PNET）病例。大多数病例通常伴有大肿瘤大小或转移性疾病。内镜超声（EUS）已被公认为早期检测胰腺恶性肿瘤的最敏感工具。它现在也已被开发用于治疗胰腺癌，如肿瘤消融治疗。我们介绍了 4 例不同类型的 PNET 患者（1 例无功能性 PNET 患者和 3 例功能性 PNET 患者），他们通过 EUS 引导下的射频消融（RFA）成功治疗，在随访期间肿瘤生长得到了很好的控制。1 例大尺寸胰岛素瘤患者在经过几次 EUS-RFA 治疗后，肿瘤逐渐得到控制。在 EUS-RFA 过程中和之后，没有观察到不良事件或重大并发症。EUS 不仅已被证明是一种更准确诊断的有前途的工具，而且还可用于控制肿瘤生长。然而，需要进一步比较 EUS 和手术方法的研究，以制定更好的治疗策略。
