EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1.

Abstract

BACKGROUND:

In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (pNETs) are the leading MEN1-related cause of death.

OBJECTIVE:

To evaluate EUS and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET), compared with the recommended screening techniques in MEN1 patients for early detection of pNETs.

DESIGN:

Cross-sectional study.

SETTING:

Tertiary-care university medical center.

PATIENTS:

This study involved 41 patients with a proven MEN1 mutation or with one MEN1 manifestation and a mutation carrier as a first-degree family member, with recent screening by abdominal CT or magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS).

INTERVENTIONS:

EUS by using a linear Pentax echoendoscope and Hitachi EUB-525 and (11)C-5-HTP PET.

MAIN OUTCOME MEASUREMENTS:

Patient-based and lesion-based positivity for pNET was calculated for all imaging techniques. The McNemar test was used to compare the yield of the 4 imaging techniques.

RESULTS:

In 35 of 41 patients, 107 pancreatic lesions were detected in total. EUS detected 101 pancreatic lesions in 34 patients, (11)C-5-HTP PET detected 35 lesions in 19 patients, and CT/MRI + SRS detected 32 lesions in 18 patients (P < .001). (11)C-5-HTP PET performed similarly to CT/MRI + SRS and better compared with SRS only (13 lesions in 12 patients), both at a patient-based and lesion-based level (P < .05).

LIMITATIONS:

Single-center study.

CONCLUSION:

EUS is superior to CT/MRI + SRS for pancreatic lesion detection in patients with MEN1. In this setting, (11)C-5-HTP PET is not useful. We recommend EUS as the first-choice pancreas imaging technique in patients with MEN1. (

CLINICAL TRIAL REGISTRATION NUMBER:

NTR1668.).

• Authors: Sophie J van Asselt, Adrienne H Brouwers, Hendrik M van Dullemen, Eric J van der Jagt, Alfons H H Bongaerts, Ido P Kema, Klaas P Koopmans, Gerlof D Valk, Henri J Timmers, Wouter W de Herder, Richard A Feelders, Paul Fockens, Wim J Sluiter, Elisabeth G E de Vries, Thera P Links
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 81 Issue 1 Pg. 159-167.e2 (Jan 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25527055 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Carbon Radioisotopes
• Radiopharmaceuticals
• 5-Hydroxytryptophan

Topics

• 5-Hydroxytryptophan
• Adolescent
• Adult
• Aged
• Carbon Radioisotopes
• Cross-Sectional Studies
• Early Detection of Cancer
• Endosonography
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multiple Endocrine Neoplasia Type 1 (complications, diagnosis)
• Neuroendocrine Tumors (diagnosis, etiology)
• Pancreas (diagnostic imaging)
• Pancreatic Neoplasms (diagnosis, etiology)
• Positron-Emission Tomography
• Prospective Studies
• Radiopharmaceuticals
• Sensitivity and Specificity
• Tomography, X-Ray Computed
• Young Adult