A Single-Center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors,Annals of Surgery

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A Single-Center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors
Annals of Surgery ( IF 7.5 ) Pub Date : 2022-08-05 , DOI: 10.1097/sla.0000000000005615
Stefano Partelli _{1,

2,

3} , Francesca Muffatti _{1,

2} , Valentina Andreasi _{1,

2,

3} , Fabio Giannone _{1,

2,

3} , Gemma Rossi _{1,

2,

4} , Diego Palumbo _{1,

3,

5} , Paola Mapelli _{1,

6} , Marco Schiavo Lena _{1,

7} , Paolo Giorgio Arcidiacono _{1,

2,

4} , Francesco De Cobelli _{1,

2,

5} , Maria Picchio _{1,

2,

6} , Claudio Doglioni _{1,

2,

7} , Massimo Falconi _{1,

2,

3}

Affiliation

Objective:

To determine the accuracy of preoperative imaging, including contrast-enhanced computed tomography (CE-CT), endoscopic ultrasound (EUS) and ⁶⁸Gallium-DOTATOC positron emission tomography (⁶⁸Ga-DOTATOC PET), in identifying nodal metastases (N+) in sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs).

Summary Background Data:

An accurate preoperative identification of N+ in NF-PanNETs is critical for surgical planning. The accuracy of different imaging techniques in detecting lymph node (LN) metastases in NF-PanNETs has been poorly investigated.

Methods:

All consecutive patients undergoing surgery for sporadic NF-PanNETs (2018-2021) were enrolled in a prospective study (DETECTYON; NCT03918759). The accuracy of preoperative imaging techniques in detecting N+ was assessed through sensitivity, specificity, positive (PPV) and negative predictive values (NPV).

Results:

Overall, 100 patients with NF-PanNETs underwent CE-CT, EUS and ⁶⁸Ga-DOTATOC-PET before pancreatic resection. LN metastases were found in 42 cases (42%). Sensitivity, specificity, PPV and NPV of different imaging techniques were 26%, 95%, 79%, 64% for CE-CT, 19%, 98%, 89%, 63% for EUS and 12%, 95%, 63%, 60% for ⁶⁸Ga-DOTATOC-PET, respectively. Radiological tumor size >4 cm and the presence of radiological N+ at ≥1 imaging were independent predictors of N+ at pathology. The identification of N+ at ≥1 imaging technique was associated with a higher number of positive LNs compared to negative imaging (4 vs. 2) (P=0.012).

Conclusions:

CE-CT, EUS and ⁶⁸Ga-DOTATOC-PET are poorly sensitive in predicting nodal status in NF-PanNETs despite a high specificity.

中文翻译：

一项单中心前瞻性观察研究，调查术前诊断程序在评估无功能胰腺神经内分泌肿瘤淋巴结转移中的准确性

客观的：

确定术前成像的准确性，包括对比增强计算机断层扫描 (CE-CT)、内窥镜超声 (EUS) 和⁶⁸镓-DOTATOC 正电子发射断层扫描 ( ⁶⁸ Ga-DOTATOC PET)，以识别散发性淋巴结转移 (N+)无功能的胰腺神经内分泌肿瘤（NF-PanNETs）。

摘要背景数据：

NF-PanNETs 中 N+ 的准确术前识别对于手术计划至关重要。不同成像技术在检测 NF-PanNETs 中淋巴结 (LN) 转移方面的准确性一直没有得到很好的研究。

方法：

所有连续接受零星 NF-PanNETs 手术的患者（2018-2021 年）都参加了一项前瞻性研究（DETECTYON；NCT03918759）。通过敏感性、特异性、阳性 (PPV) 和阴性预测值 (NPV) 评估术前成像技术检测 N+ 的准确性。

结果：

总体而言，100 名 NF-PanNETs 患者在胰腺切除前接受了 CE-CT、EUS 和⁶⁸ Ga-DOTATOC-PET。42 例 (42%) 发现 LN 转移。不同成像技术的敏感性、特异性、PPV 和 NPV 分别为 CE-CT 的 26%、95%、79%、64%，EUS 的 19%、98%、89%、63% 和 12%、95%、63% , ⁶⁸ Ga-DOTATOC-PET 分别为 60% 。放射肿瘤大小 > 4 cm 和≥1 次影像学存在放射 N+ 是病理 N+ 的独立预测因子。与阴性成像相比，在≥1 成像技术中识别出 N+ 与更多的阳性 LN 相关（4 对 2）（P = 0.012）。