EUS-FNA predicts 5-year survival in pancreatic endocrine tumors

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.

Abbreviations: BBWDET, well-differentiated endocrine tumor of probable benign behavior, PET, pancreatic endocrine tumor, F-PET, functioning PET, NF-PET, nonfunctioning PET, PDEC, poorly differentiated endocrine carcinoma, UBWDET, well-differentiated endocrine tumor of uncertain behavior, WDEC, well-differentiated endocrine carcinoma, WHO, World Health Organization