Sophie J van Asselt1, Adrienne H Brouwers2, Hendrik M van Dullemen3, Eric J van der Jagt4, Alfons H Bongaerts5, Klaas P Koopmans6, Ido P Kema7, Bernard A Zonnenberg8, Henri J Timmers9, Wouter W de Herder10, Wim J Sluiter11, Elisabeth G de Vries12, Thera P Links13. 1. Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 2. Department of Nuclear Medicine and Molecular ImagingUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 3. Department of GastroenterologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of RadiologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 5. Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Nuclear Medicine and Molecular ImagingUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 6. Department of Nuclear Medicine and Molecular ImagingMartini Hospital Groningen, Groningen, The Netherlands. 7. Department of Laboratory MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 8. Department of Internal MedicineUniversity Medical Center Utrecht, Utrecht, The Netherlands. 9. Department of MedicineDivisioin of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 10. Department of EndocrinologyErasmus Medical Center, Rotterdam, The Netherlands. 11. Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 12. Department of Medical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 13. Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands t.p.links@umcg.nl.
Abstract
BACKGROUND: Patients with von Hippel-Lindau (VHL) disease are prone to develop pancreatic neuroendocrine tumors (pNETs). However, the best imaging technique for early detection of pNETs in VHL is currently unknown. In a head-to-head comparison, we evaluated endoscopic ultrasound (EUS) and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET) compared with conventional screening techniques for early detection of pancreatic solid lesions in VHL patients. METHODS: We conducted a cross-sectional, prospective study in 22 patients at a tertiary care university medical center. Patients with VHL mutation or with one VHL manifestation and a mutation carrier as first-degree family member, with recent screening by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS), were eligible. Patients underwent EUS by linear Pentax echoendoscope and Hitachi EUB-525, and (11)C-5-HTP PET. Patient-based and lesion-based positivity for pancreatic solid lesions were calculated for all imaging techniques with a composite reference standard. RESULTS: In 10 of the 22 patients, 20 pancreatic solid lesions were detected: 17 with EUS (P < 0.05 vs CT/MRI+ SRS), 3 with (11)C-5-HTP PET, 3 with SRS, 9 with CT/MRI, and 9 with CT/MRI + SRS. EUS evaluations showed solid lesions with a median size of 9.7 mm (range 2.9-55 mm) and most of them were homogeneous, hypoechoic, isoelastic, and hypervascular. Moreover, EUS detected multiple pancreatic cysts in 18 patients with a median of 4 cysts (range 1-30). CONCLUSIONS: EUS is superior to CT/MRI + SRS for detecting pancreatic solid lesions in VHL disease.(11)C-5-HTP PET has no value as a screening method in this setting. EUS performs well in early detection of pNETs, but its role in VHL surveillance is unclear.
BACKGROUND:Patients with von Hippel-Lindau (VHL) disease are prone to develop pancreatic neuroendocrine tumors (pNETs). However, the best imaging technique for early detection of pNETs in VHL is currently unknown. In a head-to-head comparison, we evaluated endoscopic ultrasound (EUS) and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET) compared with conventional screening techniques for early detection of pancreatic solid lesions in VHLpatients. METHODS: We conducted a cross-sectional, prospective study in 22 patients at a tertiary care university medical center. Patients with VHL mutation or with one VHL manifestation and a mutation carrier as first-degree family member, with recent screening by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS), were eligible. Patients underwent EUS by linear Pentax echoendoscope and Hitachi EUB-525, and (11)C-5-HTP PET. Patient-based and lesion-based positivity for pancreatic solid lesions were calculated for all imaging techniques with a composite reference standard. RESULTS: In 10 of the 22 patients, 20 pancreatic solid lesions were detected: 17 with EUS (P < 0.05 vs CT/MRI+ SRS), 3 with (11)C-5-HTP PET, 3 with SRS, 9 with CT/MRI, and 9 with CT/MRI + SRS. EUS evaluations showed solid lesions with a median size of 9.7 mm (range 2.9-55 mm) and most of them were homogeneous, hypoechoic, isoelastic, and hypervascular. Moreover, EUS detected multiple pancreatic cysts in 18 patients with a median of 4 cysts (range 1-30). CONCLUSIONS: EUS is superior to CT/MRI + SRS for detecting pancreatic solid lesions in VHL disease.(11)C-5-HTP PET has no value as a screening method in this setting. EUS performs well in early detection of pNETs, but its role in VHL surveillance is unclear.
Authors: Barbara Braden; Christian Jenssen; Mirko D'Onofrio; Michael Hocke; Uwe Will; Kathleen Möller; Andre Ignee; Yi Dong; Xin-Wu Cui; Adrian Sãftoiu; Christoph F Dietrich Journal: Endosc Ultrasound Date: 2017 Jan-Feb Impact factor: 5.628
Authors: Myrthe R Naber; Saya Ahmad; Annemarie A Verrijn Stuart; Rachel H Giles; Gerlof D Valk; Rachel S van Leeuwaarde Journal: J Endocr Soc Date: 2021-12-22