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

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

doi:10.1016/j.gie.2014.09.037

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

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

Research output: Contribution to journal › Article › Academic › peer-review

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.).

Original language	English
Pages (from-to)	159-167.e2
Journal	Gastrointestinal Endoscopy
Volume	81
Issue number	1
DOIs	https://doi.org/10.1016/j.gie.2014.09.037
Publication status	Published - Jan 2015

Keywords

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
Neuroendocrine Tumors
Pancreas
Pancreatic Neoplasms
Positron-Emission Tomography
Prospective Studies
Radiopharmaceuticals
Sensitivity and Specificity
Tomography, X-Ray Computed
Young Adult

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10.1016/j.gie.2014.09.037

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van Asselt, S. J., Brouwers, A. H., van Dullemen, H. M., van der Jagt, E. J., Bongaerts, A. H. H., Kema, I. P., Koopmans, K. P., Valk, G. D., Timmers, H. J., de Herder, W. W., Feelders, R. A., Fockens, P., Sluiter, W. J., de Vries, E. G. E., & Links, T. P. (2015). EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1. Gastrointestinal Endoscopy, 81(1), 159-167.e2. https://doi.org/10.1016/j.gie.2014.09.037

@article{53e3a46c337c4c4fb0e50c3f0b153194,

title = "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.).",

keywords = "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, Neuroendocrine Tumors, Pancreas, Pancreatic Neoplasms, Positron-Emission Tomography, Prospective Studies, Radiopharmaceuticals, Sensitivity and Specificity, Tomography, X-Ray Computed, Young Adult",

author = "{van Asselt}, {Sophie J} and Brouwers, {Adrienne H} and {van Dullemen}, {Hendrik M} and {van der Jagt}, {Eric J} and Bongaerts, {Alfons H H} and Kema, {Ido P} and Koopmans, {Klaas P} and Valk, {Gerlof D.} and Timmers, {Henri J} and {de Herder}, {Wouter W} and Feelders, {Richard A} and Paul Fockens and Sluiter, {Wim J} and {de Vries}, {Elisabeth G E} and Links, {Thera P}",

year = "2015",

month = jan,

doi = "10.1016/j.gie.2014.09.037",

language = "English",

volume = "81",

pages = "159--167.e2",

journal = "Gastrointestinal Endoscopy",

issn = "0016-5107",

publisher = "Mosby Inc.",

number = "1",

}

van Asselt, SJ, Brouwers, AH, van Dullemen, HM, van der Jagt, EJ, Bongaerts, AHH, Kema, IP, Koopmans, KP, Valk, GD, Timmers, HJ, de Herder, WW, Feelders, RA, Fockens, P, Sluiter, WJ, de Vries, EGE & Links, TP 2015, 'EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1', Gastrointestinal Endoscopy, vol. 81, no. 1, pp. 159-167.e2. https://doi.org/10.1016/j.gie.2014.09.037

TY - JOUR

T1 - EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1

AU - van Asselt, Sophie J

AU - Brouwers, Adrienne H

AU - van Dullemen, Hendrik M

AU - van der Jagt, Eric J

AU - Bongaerts, Alfons H H

AU - Kema, Ido P

AU - Koopmans, Klaas P

AU - Valk, Gerlof D.

AU - Timmers, Henri J

AU - de Herder, Wouter W

AU - Feelders, Richard A

AU - Fockens, Paul

AU - Sluiter, Wim J

AU - de Vries, Elisabeth G E

AU - Links, Thera P

PY - 2015/1

Y1 - 2015/1

N2 - 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.).

AB - 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.).

KW - 5-Hydroxytryptophan

KW - Adolescent

KW - Adult

KW - Aged

KW - Carbon Radioisotopes

KW - Cross-Sectional Studies

KW - Early Detection of Cancer

KW - Endosonography

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Multiple Endocrine Neoplasia Type 1

KW - Neuroendocrine Tumors

KW - Pancreas

KW - Pancreatic Neoplasms

KW - Positron-Emission Tomography

KW - Prospective Studies

KW - Radiopharmaceuticals

KW - Sensitivity and Specificity

KW - Tomography, X-Ray Computed

KW - Young Adult

U2 - 10.1016/j.gie.2014.09.037

DO - 10.1016/j.gie.2014.09.037

M3 - Article

C2 - 25527055

SN - 0016-5107

VL - 81

SP - 159-167.e2

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 1

ER -

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

Abstract

Keywords

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