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Cystic Pancreatic Neuroendocrine Neoplasms: A Multicenter International Cohort Study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
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2019 (English)In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 108, no Suppl. 1, p. 245-245Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Natural history of cystic pancreatic neuroendocrine neoplasms (cPanNENs) is unknown, and their clinical management remains unclear. An observational strategy for asymptomatic cPanNENs ≤2cm has been proposed by recent guidelines, but evidence is scarce and limited to single-institutional series.

Aim(s): Analyze a large international cohort of cPanNENs.

Materials and methods: All resected cPanNENs (1995-2017) from 16 institutions worldwide were included. Solid lesions (>50% solid component), functional tumors and MEN-1 patients were excluded. Malignancy was defined as G3 grading, lymph node (LN) involvement, metastasis and/or recurrence.

Results: Overall, 263 resected cPanNENs were included, among which 177 (63.5%) were preoperatively >2cm. A preoperative diagnosis of cPanNEN was established in 162 cases (61.6%) and was more frequent when patients underwent endoscopic ultrasound (EUS, OR 3.01, 95%CI 1.66-5.44) and nuclear medicine investigations (OR 3.97, 95%CI 1.93-8.18), and for those managed in high-volume institutions (OR 3.48, 95%CI 1.88-6.45). Forty-one cPanNENs (15.6%) were malignant. Suspicion of LN involvement on imaging, age >65 years, preoperative size >2cm and pancreatic duct dilation were independently associated with malignancy in the whole cohort. In asymptomatic patients, older age and a preoperative size >2cm remained independently associated with malignancy. Notably, malignancy occurred in only 1/61 asymptomatic patients with a preoperative size ≤2cm.

Conclusion: The diagnostic accuracy of cPanNENs is increased by the use of EUS and nuclear medicine investigations and is higher in high-volume institutions. A preoperative size >2cm is independently associated with malignancy, so that a wait-and-see policy for sporadic asymptomatic cPanNENs≤ 2cm seems justified.

Place, publisher, year, edition, pages
S. Karger, 2019. Vol. 108, no Suppl. 1, p. 245-245
Keywords [en]
cystic pancreatic neuroendocrine tumors, surgery
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-157793DOI: 10.1159/000498996ISI: 000460981800246OAI: oai:DiVA.org:umu-157793DiVA, id: diva2:1301742
Conference
16th Annual ENETS Conference, 6-8 March 2019, Barcelona, Spain
Available from: 2019-04-02 Created: 2019-04-02 Last updated: 2019-04-02Bibliographically approved

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Westermark, SofiaSund, Malin

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