Abhik Bhattacharya

Diagnostic Differentiation of Pancreatic Neuroendocrine Tumor From Other Neoplastic Solid Pancreatic Lesions During Endoscopic Ultrasound-Guided Fine-Needle Aspiration.

Objectives To identify factors differentiating pancreatic neuroendocrine tumors (PNETs) from non-PNET neoplastic solid pancreatic lesions (SPLs) and assess the accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Methods This is a retrospective study at a tertiary center of consecutive patients referred for EUS from 2004 to 2011. The main outcomes were pretest predictors and accuracy of EUS-FNA for diagnosis of PNET. Results Among a total of 1108 EUS-FNAs for pancreatic lesions, 672 patients (PNET = 91, non-PNET neoplastic-SPLs = 581) had neoplastic-SPLs. The sensitivity, specificity, and accuracy of EUS-FNA for diagnosis of PNETs were 98.9%, 100%, and 99.9%, respectively. The mean needle-passes were 3.0/patient. The EUS volume (mean/year per endosonographer) in preceding 3 years significantly correlated with fewer needle passes (rs: [−0.26]; P = 0.02). Multivariate analysis demonstrated that patients with PNET when compared to non-PNET neoplastic-SPLs were younger (odds ratio [OR], 3.23; 95% confidence interval [95% CI], 1.19–9.09; P = 0.001), have 2 or more pancreatic lesions (OR, 5.63; 95% CI, 1.74–18.2; P = 0.005), and lower CA 19-9 values (OR, 10.0; 95% CI, 3.13–33.3; P = 0.001). Further, PNETs were less likely to have weight loss (OR, 0.40; 95% CI, 0.17–0.90; P = 0.03), current smoking (OR, 0.47; 95% CI, 0.22–0.98; P < 0.05), pancreatic ductal dilation (OR, 0.28; 95% CI, 0.13–0.60; P = 0.002), or imaging evidence of arterial invasion (OR, 0.22; 95% CI, 0.07–0.71; P = 0.01). Conclusions Although pre-FNA findings can reliably characterize, EUS-FNA is highly accurate for the diagnosis of PNETs.

Pretest prediction and diagnosis of metastatic lesions to the pancreas by endoscopic ultrasound‐guided fine needle aspiration

Early diagnosis of solid pancreatic lesions (SPLs) enables prompt treatment. The study aims to identify factors differentiating metastatic lesion to the pancreas (PMET) from pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (PNETs).