PMID- 22382771
OWN - NLM
STAT- MEDLINE
DCOM- 20120907
LR  - 20211021
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 36
IP  - 6
DP  - 2012 Jun
TI  - Preoperative assessment of the pancreas in multiple endocrine neoplasia type 1.
PG  - 1375-81
LID - 10.1007/s00268-012-1539-7 [doi]
AB  - BACKGROUND: Many serologic and radiographic modalities are used for monitoring 
      multiple endocrine neoplasia type 1 (MEN 1) patients for pancreaticoduodenal 
      neuroendocrine tumors (PNETs). We compared serum markers and imaging studies 
      obtained preoperatively with the gross pathology and immunohistochemical findings 
      and correlated preoperative testing with postoperative outcome. METHODS: From 
      2000 to 2008, 52 MEN 1 patients [32 (62%) female; median age = 43 years, range 
      19-74 years] underwent 56 pancreatic operations [49 (88%) distal 
      pancreatectomies] for suspected PNETs. Preoperative serum markers [human 
      pancreatic polypeptide (HPP), gastrin, and glucagon] and imaging [CT, (111)In 
      pentetreotide scintigraphy, and endoscopic ultrasound (EUS)] were compared to the 
      pathologic findings. Postoperative serum markers and survival were followed. 
      RESULTS: Human pancreatic polypeptide had the highest agreement between an 
      elevated serum level and positive tumor immunostaining (83% vs. 50% agreement for 
      gastrin vs. 67% agreement for glucagon). Preoperative CT had 81% sensitivity and 
      positive predictive value (PPV) of 97% for PNETs. (111)In pentetreotide 
      scintigraphy had 84% sensitivity and PPV of 96%. Preoperative endoscopic 
      ultrasonography (EUS) had 100% sensitivity and PPV, with close correlation (r 
      (s) = 0.93) between the largest lesion seen on EUS and pathology. Median 
      follow-up was 4.3 years (range = 0.1-10.9 years). Overall survival was 89% at 
      5-year follow-up. CONCLUSIONS: Our study substantiates EUS as providing the 
      highest preoperative sensitivity and PPV in assessing the presence of PNETs in 
      MEN 1 patients. CT and octreotide scintigraphy can yield both false-positive and 
      false-negative results. HPP, gastrin, and glucagon were the most commonly 
      measured tumor markers in our series but did not always correlate with 
      immunostaining. With an aggressive surgical approach, satisfactory rates of 
      biochemical improvement and long-term survival were observed.
FAU - Lewis, Mark A
AU  - Lewis MA
AD  - Division of Medical Oncology, Department of Oncology, Mayo Clinic, 200 First 
      Street SW, Rochester, MN 55905, USA. lewis.mark2@mayo.edu
FAU - Thompson, Geoffrey B
AU  - Thompson GB
FAU - Young, William F Jr
AU  - Young WF Jr
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
RN  - 0 (Biomarkers)
RN  - 0 (Radiopharmaceuticals)
RN  - 51110-01-1 (Somatostatin)
RN  - G083B71P98 (pentetreotide)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - Endosonography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/blood/*diagnosis/mortality/surgery
MH  - Neuroendocrine Tumors/blood/*diagnosis/mortality/surgery
MH  - *Pancreatectomy
MH  - Pancreatic Neoplasms/blood/*diagnosis/mortality/surgery
MH  - Preoperative Care/*methods
MH  - Radiopharmaceuticals
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Somatostatin/analogs & derivatives
MH  - Survival Rate
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2012/03/03 06:00
MHDA- 2012/09/08 06:00
CRDT- 2012/03/03 06:00
PHST- 2012/03/03 06:00 [entrez]
PHST- 2012/03/03 06:00 [pubmed]
PHST- 2012/09/08 06:00 [medline]
AID - 10.1007/s00268-012-1539-7 [doi]
PST - ppublish
SO  - World J Surg. 2012 Jun;36(6):1375-81. doi: 10.1007/s00268-012-1539-7.