EUS-FNA predicts 5-year survival in pancreatic endocrine tumors
Received 17 November 2008; accepted 6 May 2009. published online 30 July 2009.
Background
Pancreatic endocrine tumors (PETs) differ in clinical behavior and prognosis. Determination of malignant potential through specimens obtained by EUS-FNA can help in the management of these patients.
Objective
To determine the value of EUS-FNA for diagnosing PETs and for classifying their underlying malignant potential based on the World Health Organization (WHO) classification.
Design
Single-center, retrospective, cohort study.
Setting
Tertiary referral hospital.
Patients
This study involved 86 consecutive patients (44 men, mean age 58 ± 14 years) who had been diagnosed with PETs and submitted to EUS-FNA from January 1999 to August 2008.
Intervention
EUS-FNA of a pancreatic mass and/or a metastasis site. Immunohistochemistry on microbiopsies or on monolayer cytology was routinely used. The lesions were classified as recommended by the WHO.
Main Outcome Measurements
EUS-FNA sensitivity and 5-year survival rate.
Results
Overall, in 90% (77 of 86) of patients in this study, PET was diagnosed with EUS-FNA. The sensitivity did not vary with tumor size, type, location, or the presence of hormonal secretion. Of 86 patients, 30 (35%) were submitted to surgical resection. The kappa correlation index between the WHO classification obtained by EUS-FNA and by surgery was 0.38 (P = .003). Major discrepancies were found in the group of patients diagnosed with endocrine tumor of uncertain behavior by EUS-FNA, because 72% turned out to have well-differentiated endocrine carcinoma. Sixteen patients (27%) died during a mean follow-up period of 34 ± 27 months. The 5-year survival rates were 100% for endocrine tumors, 68% for well-differentiated endocrine carcinomas, and 30% for poorly differentiated endocrine carcinomas (P = .008, log-rank test).
Limitations
Retrospective design, selection bias, and small sample size.
Conclusions
This largest single-center experience to date demonstrated the accuracy of EUS-FNA in diagnosing and determining the malignant behavior of PETs. EUS-FNA findings predict 5-year survival in patients with PETs.
Current affiliations: Unité d'Exploration Médico-Chirurgicale Oncologique, Institut Paoli-Calmettes, France (F.A.F.F., M.G., E.B., C.P., F.C.), Gastroenterology Department, University of the State of Rio de Janeiro and Federal University of Rio de Janeiro, Brazil (F.A.F.F.), Biopathology Unit, Institut Paoli-Calmettes, France (G.M.), Surgical Unit, Institut Paoli-Calmettes, France (J.R.D.)
Reprint requests: Fátima Aparecida Ferreira Figueiredo, MD, PhD, Gastroenterology Department - University of the State of Rio de Janeiro, Rua Humaitá 282 Bl II Ap 1703 Humaitá, Rio de Janeiro, Brazil 22261001.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact him at faff@gbl.com.br.
ABSTRACT