Multicenter Study on the Performance of Imaging Tests Compared to Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Solid Pseudopapillary Neoplasms of the Pancreas

• Published in: GE Portuguese journal of gastroenterology Vol. 30; no. 5; pp. 375 - 383
• Main Authors: Ricardo, Vítor Doria, Marchetti, Giulia, de Almeida, Arthur Ferraz, Lopes, César Vivian, Reis, Jerusa dos Santos, Bonin, Eduardo Aimoré, de Araújo, Wladimir Campos, Machado, Marcel Autran, Romanini, Samuel Galante, Ardengh, José Celso
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-10-2023; Karger Publishers
• Subjects: Bile ducts; Biopsy; Cysts; diagnosis; endoscopic ultrasound; endoscopic ultrasound-guided fine-needle aspiration; Endoscopy; Medical diagnosis; Pancreatic cancer; pancreatic neoplasm; pathology/surgery; Patients; Research Article; Research ethics; solid-pseudopapillary neoplasm; solid-pseudopapillary tumor; Statistical analysis; Surgery; Tumors; Brazil; Endoscopic ultrasound-guided fine-needle aspiration; Solid-pseudopapillary neoplasm; Pancreatic neoplasm; Pancreatic cancer; Pathology/surgery; Diagnosis; Solid-pseudopapillary tumor; Endoscopic ultrasound
• DOI: 10.1159/000525994
• EISSN: 2387-1954
• ISSN: 2341-4545

Abstract
Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. The final diagnosis was obtained after the anatomopathological examination of the surgical specimen in all patients (gold standard), and we compared the results of CT, MRI/MRCP, EUS, and the McH with the gold standard. Results: Fifty-four patients were included in the study, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2% patients. SPN was detected incidentally in 32 (59%) patients. The average size of the tumors was 3.8 cm (SD: 2.26). The most common finding at EUS was a solid, solid/cystic, and cystic lesion in 52.9%, 41.1%, and 7.8% patients, respectively. The final diagnosis was 51 patients with SPN and 3 with nonfunctioning pancreatic neuroendocrine tumors (NF-NET). The correct diagnosis was made by CT, MRI/MRCP, EUS isolated, and EUS-FNA in 21.9%, 28.88%, 64.71%, and 88.24%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance from 22.72% to 94.11% and from 29.16% to 94.11%, respectively. Conclusions: SPN are rare, incidentally identified in most cases, and affect young women. Differential diagnosis between SPN, NF-NET, and other types of tumors with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in case of diagnostic doubt and should be used whenever necessary to rule out NF-NET or other type of solid/cystic nodular lesion of the pancreas.