Diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration for cystic and non-cystic pancreatic neuroendocrine tumors

Background and study aims Pancreatic neuroendocrine tumors (P-NENs) are rare tumors with malignant potential. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been shown to be superior to other imaging methods in preoperative localization and diagnosis of P-NENs. The objective of this study was to describe the EUS features of non-metastatic cystic and non-cystic P-NENs seen at a referral center and to evaluate the performance of EUS-FNA in diagnosis of P-NENs. Patients and methods All patients with histologically confirmed, non-metastatic P-NENs, which underwent EUS-FNA prior to surgical resection at the Moffitt Cancer Center between Jan 2005 and Dec 2012 were included. Clinical, endoscopic and pathologic information was abstracted from electronic medical records. Results Thirty-nine patients, all with non-functional P-NENs, were included in this study. Thirteen tumors were cystic and 26 were solid. Among the cystic tumors, 50 % were partly cystic and partly solid, and 50 % were fully cystic. The cystic tumors were more commonly seen at the body/tail, and the solid tumors were more uniformly distributed. Fluid could be aspirated from 50 % of the cystic tumors, all with a carcinoembryonic antigen level < 192 ng/mL. With surgical pathology as the gold standard, overall sensitivity of EUS-FNA in diagnosing cystic tumors was 62.5 %, and for solid tumors, 95 % (P < 0.03). Conclusions EUS-FNA is much more sensitive in diagnosing solid P-NENs than cystic PNETs. Our results indicate that EUS-FNA may have higher sensitivity for diagnosis of cystic P-NENs than the reported sensitivity of EUS-FNA for all pancreatic cystic tumors.