Paul D James1, Apostolos V Tsolakis2, Mei Zhang3, Paul J Belletrutti4, Rachid Mohamed4, Derek J Roberts5, Steven J Heitman4. 1. Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 2. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden. 3. Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden. 4. Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 5. Department of Surgery and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Current guidelines recommend CT scan or magnetic resonance imaging as the initial imaging modalities for the work-up of suspected pancreatic neuroendocrine tumors (PNETs). OBJECTIVE: To determine the incremental benefit of preoperative EUS (IBEUS) for the detection of suspected PNETs after other investigative modalities have been attempted. DESIGN: This systematic review searched MEDLINE, EMBASE, bibliographies of included articles, and conference proceedings for studies reporting original data regarding the preoperative detection of PNETs. Pooled IBEUS was calculated by using random effects models. Heterogeneity was explored by using stratified meta-analysis and meta-regression. Evidence of small-study effects was assessed by using funnel plots and the Begg test. PATIENTS: Patients with suspected PNETs. INTERVENTIONS: EUS evaluation. MAIN OUTCOME MEASUREMENTS: The pooled IBEUS for the detection of PNETs after CT scan, with or without additional investigative modalities. RESULTS: Among 4505 citations identified, we included 17 cohort studies (612 patients). EUS identified PNETs in 97% of cases. Improved PNET identification with EUS was observed in all of the studies. After adjusting for small-study effects, meta-analysis showed that EUS alone could identify PNETs in approximately 1 in 4 patients (adjusted IBEUS 26%; 95% confidence interval, 17%-37%). The pooled IBEUS varied based on the study design, study size, type of CT scan used, and the number of modalities used prior to EUS. LIMITATIONS: The majority of included studies were retrospective. Small-study effects were observed. CONCLUSION: Preoperative EUS is associated with an increase in PNET detection after other modalities are attempted.
BACKGROUND: Current guidelines recommend CT scan or magnetic resonance imaging as the initial imaging modalities for the work-up of suspected pancreatic neuroendocrine tumors (PNETs). OBJECTIVE: To determine the incremental benefit of preoperative EUS (IBEUS) for the detection of suspected PNETs after other investigative modalities have been attempted. DESIGN: This systematic review searched MEDLINE, EMBASE, bibliographies of included articles, and conference proceedings for studies reporting original data regarding the preoperative detection of PNETs. Pooled IBEUS was calculated by using random effects models. Heterogeneity was explored by using stratified meta-analysis and meta-regression. Evidence of small-study effects was assessed by using funnel plots and the Begg test. PATIENTS: Patients with suspected PNETs. INTERVENTIONS: EUS evaluation. MAIN OUTCOME MEASUREMENTS: The pooled IBEUS for the detection of PNETs after CT scan, with or without additional investigative modalities. RESULTS: Among 4505 citations identified, we included 17 cohort studies (612 patients). EUS identified PNETs in 97% of cases. Improved PNET identification with EUS was observed in all of the studies. After adjusting for small-study effects, meta-analysis showed that EUS alone could identify PNETs in approximately 1 in 4 patients (adjusted IBEUS 26%; 95% confidence interval, 17%-37%). The pooled IBEUS varied based on the study design, study size, type of CT scan used, and the number of modalities used prior to EUS. LIMITATIONS: The majority of included studies were retrospective. Small-study effects were observed. CONCLUSION: Preoperative EUS is associated with an increase in PNET detection after other modalities are attempted.
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327
Authors: Paul D James; Mae Hegagi; Lilia Antonova; Jill Tinmouth; Steven J Heitman; Carmine Simone; Elaine Yeung; Elaine Yong Journal: CMAJ Open Date: 2017-06-07