EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors

Mouen A. Khashab, Elaine Yong, Anne Marie Lennon, Eun Ji Shin, Stuart Amateau, Ralph H. Hruban, Kelly Olino, Samuel Giday, Elliot K. Fishman, Christopher L. Wolfgang, Barish H. Edil, Martin Makary, Marcia Irene Canto

Research output: Contribution to journalArticle

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Abstract

Background The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging. Objective The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs. Design Retrospective single-center cohort study. Setting Johns Hopkins Hospital. Patients Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded. Main Outcome Measurement Detection rates of CT and EUS were compared by using pathology as the reference standard. Results In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ2 for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%). Limitations Retrospective nonrandomized design and referral bias. Conclusions The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.

Original languageEnglish (US)
Pages (from-to)691-696
Number of pages6
JournalGastrointestinal Endoscopy
Volume73
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

Fingerprint

Neuroendocrine Tumors
Tomography
Insulinoma
Technology
Neoplasms
Cohort Studies
Referral and Consultation
Pathology

Keywords

  • Abbreviations
  • JHH
  • Johns Hopkins Hospital
  • MDCT
  • multidetector CT
  • pancreatic neuroendocrine tumors
  • PNETs
  • vasoactive intestinal peptide-secreting tumors
  • VIPomas

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Khashab, M. A., Yong, E., Lennon, A. M., Shin, E. J., Amateau, S., Hruban, R. H., ... Canto, M. I. (2011). EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointestinal Endoscopy, 73(4), 691-696. https://doi.org/10.1016/j.gie.2010.08.030

EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. / Khashab, Mouen A.; Yong, Elaine; Lennon, Anne Marie; Shin, Eun Ji; Amateau, Stuart; Hruban, Ralph H.; Olino, Kelly; Giday, Samuel; Fishman, Elliot K.; Wolfgang, Christopher L.; Edil, Barish H.; Makary, Martin; Canto, Marcia Irene.

In: Gastrointestinal Endoscopy, Vol. 73, No. 4, 04.2011, p. 691-696.

Research output: Contribution to journalArticle

Khashab, MA, Yong, E, Lennon, AM, Shin, EJ, Amateau, S, Hruban, RH, Olino, K, Giday, S, Fishman, EK, Wolfgang, CL, Edil, BH, Makary, M & Canto, MI 2011, 'EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors', Gastrointestinal Endoscopy, vol. 73, no. 4, pp. 691-696. https://doi.org/10.1016/j.gie.2010.08.030
Khashab, Mouen A. ; Yong, Elaine ; Lennon, Anne Marie ; Shin, Eun Ji ; Amateau, Stuart ; Hruban, Ralph H. ; Olino, Kelly ; Giday, Samuel ; Fishman, Elliot K. ; Wolfgang, Christopher L. ; Edil, Barish H. ; Makary, Martin ; Canto, Marcia Irene. / EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. In: Gastrointestinal Endoscopy. 2011 ; Vol. 73, No. 4. pp. 691-696.
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abstract = "Background The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging. Objective The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs. Design Retrospective single-center cohort study. Setting Johns Hopkins Hospital. Patients Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded. Main Outcome Measurement Detection rates of CT and EUS were compared by using pathology as the reference standard. Results In 217 patients (with 231 PNETs) studied, CT detected 84{\%} of tumors (54.3{\%} of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ2 for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7{\%} vs 63.3{\%}; P = .0002), particularly for insulinomas (84.2{\%} vs 31.6{\%}; P = .001). EUS detected 20 of 22 CT-negative tumors (91{\%}). Limitations Retrospective nonrandomized design and referral bias. Conclusions The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.",
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T1 - EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors

AU - Khashab, Mouen A.

AU - Yong, Elaine

AU - Lennon, Anne Marie

AU - Shin, Eun Ji

AU - Amateau, Stuart

AU - Hruban, Ralph H.

AU - Olino, Kelly

AU - Giday, Samuel

AU - Fishman, Elliot K.

AU - Wolfgang, Christopher L.

AU - Edil, Barish H.

AU - Makary, Martin

AU - Canto, Marcia Irene

PY - 2011/4

Y1 - 2011/4

N2 - Background The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging. Objective The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs. Design Retrospective single-center cohort study. Setting Johns Hopkins Hospital. Patients Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded. Main Outcome Measurement Detection rates of CT and EUS were compared by using pathology as the reference standard. Results In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ2 for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%). Limitations Retrospective nonrandomized design and referral bias. Conclusions The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.

AB - Background The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging. Objective The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs. Design Retrospective single-center cohort study. Setting Johns Hopkins Hospital. Patients Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded. Main Outcome Measurement Detection rates of CT and EUS were compared by using pathology as the reference standard. Results In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ2 for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%). Limitations Retrospective nonrandomized design and referral bias. Conclusions The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.

KW - Abbreviations

KW - JHH

KW - Johns Hopkins Hospital

KW - MDCT

KW - multidetector CT

KW - pancreatic neuroendocrine tumors

KW - PNETs

KW - vasoactive intestinal peptide-secreting tumors

KW - VIPomas

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DO - 10.1016/j.gie.2010.08.030

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JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

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