Manuele Furnari1, Andrea Buda2, Gabriele Delconte3, Davide Citterio4, Theodor Voiosu5, Giovanni Ballardini4, Flaminia Cavallaro3, Edoardo Savarino6, Vincenzo Mazzaferro4, Emanuele Meroni7. 1. Department of Internal Medicine, Gastroenterology Unit, IRCCS, University of Genoa, Italy. manuelefurnari@gmail.com. 2. Gastroenterology Unit, Santa Maria Del Parato Hospital, Feltre, Italy. 3. Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori,Milan, Italy. 4. Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania. 6. Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Italy. 7. Regional Hospital Beata Vergine, EOC, Mendrisio, Switzerland.
Abstract
BACKGROUND AND AIMS: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive. METHOD: Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration. RESULTS: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded. CONCLUSIONS: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.
BACKGROUND AND AIMS: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive. METHOD: Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration. RESULTS: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded. CONCLUSIONS: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.
Authors: Ajaykumar C Morani; Shiva Gupta; Khaled M Elsayes; Ahmad I Mubarak; Ahmed M Khalaf; Priya R Bhosale; Jia Sun; Corey T Jensen; Vikas Kundra Journal: J Comput Assist Tomogr Date: 2022-03-04 Impact factor: 2.081
Authors: Roberta Elisa Rossi; Alessandra Elvevi; Camilla Gallo; Andrea Palermo; Pietro Invernizzi; Sara Massironi Journal: World J Gastroenterol Date: 2022-07-14 Impact factor: 5.374