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O PAPEL ECOENDOSCOPIA NO DIAGNOSTICO DOS TUMORES NEUROENDOCRINOS PANCREATICOS

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A ecoendoscopia é excelente método para a identificação dos TUNE funcionantes ou não. Essa técnica deve ser utilizada antes da adoção do tratamento cirúrgico.
ardengh9.jpg Autor:
José celso Ardengh
Columnista Experto de SIIC

Institución:
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Artículos publicados por José celso Ardengh
Recepción del artículo
23 de Agosto, 2006 		Aprobación
11 de Septiembre, 2006
Primera edición
8 de Enero, 2007 		Segunda edición, ampliada y corregida
7 de Junio, 2021

O PAPEL ECOENDOSCOPIA NO DIAGNOSTICO DOS TUMORES NEUROENDOCRINOS PANCREATICOS

Resumen
Os tumores neuroendócrinos do pâncreas (TUNE) são raros. A literatura relata vasta maioria de tumores funcionantes (70%-85%), geralmente pequenos (< 2 cm) e sintomáticos devido à produção hormonal elevada. Os não secretores (nTUNE) geralmente apresentam sintomas decorrentes do seu tamanho e se assemelham ao adenocarcinoma do pâncreas. A localização pré-operatória desses tumores falha na maioria das vezes devido ao pequeno tamanho. A ressecção cirúrgica é o tratamento de escolha. Assim sendo, sua identificação pré-operatória é de fundamental importância. O objetivo desse trabalho é demonstrar o valor da ecoendoscopia (EE) isolada e associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico pré-operatório dos tumores neuroendócrinos e comparar seus resultados com outros testes diagnósticos utilizados para essa finalidade.

Palabras clave
pâncreas/patologia, tumor neuroendócrino/diagnóstico, estadiamento de neoplasias, biópsia por agulha, endossonografia


Artículo completo
(castellano)
Extensión:  +/-7.65 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

The Role of Endoscopy in Diagnosing Pancreatic Neuroendocrine Tumors

Abstract
Pancreatic neuroendocrine tumors (PETs) are rare. The vast majority are functional (70-85%), generally small (< 2 cm) and symptomatic due to elevated hormone production. Non-functional pancreatic neuroendocrine tumors (nPETs) usually produce symptoms based on their size and similarity to pancreatic adenocarcinoma. Localizing these tumors pre-operatively fails in most cases because of their small size. While surgical resection is the treatment of choice, pre-operative identification is of fundamental importance. The objective of the present work is to demonstrate the value of endoscopy and fine-needle aspiration in the pre-operative diagnosis and staging of neuroendocrine tumors when compared to results using other diagnostic tools.

Key words
pâncreas/pathology, neuroendocrine tumor/ diagnosis, staging, fine-needle aspiration biopsy, endoscopic ultrasound

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Imágenes
Relacionadas: Cirugía, Endocrinología y Metabolismo, Gastroenterología, Medicina Interna, Oncología



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Enviar correspondencia a:
José Celso Ardengh, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 04524-001, Alameda dos Arapanés, 881-cj 111, San Pablo, Brasil
Bibliografía del artículo
1. Meko JB, Norton JA. Endocrine tumors of the pancreas. Curr Opin Gen Surg 1994:186-94.
2. Lozano Salazar RR, Herrera MF, Hernández Ortiz J, Campuzano M. Endocrine tumors of the pancreas. Rev Gastroenterol Mex 1997; 62(3):212-7.
3. Mullan MH, Gauger PG, Thompson NW. Endocrine tumours of the pancreas: review and recent advances. ANZ J Surg 2001; 71(8):475-82.
4. Nikou GC, Toubanakis C, Nikolaou P, Giannatou E, Safioleas M, Mallas E, et al. VIPomas: an update in diagnosis and management in a series of 11 patients. Hepatogastroenterology 2005; 52(64):1259-65.
5. Zimmer T, Stolzel U, Liehr RM, Bader M, Fett U, Hamm B, et al. Somatostatin receptor scintigraphy and endoscopic ultrasound for the diagnosis of insulinoma and gastrinoma. Dtsch Med Wochenschr 1995; 120(4):87-93.
6. Madura JA, Cummings OW, Wiebke EA, Broadie TA, Goulet RL, Jr., Howard TJ. Nonfunctioning islet cell tumors of the pancreas: a difficult diagnosis but one worth the effort. Am Surg 1997; 63(7):573-7; discussion 577-8.
7. Jensen RT, Norton JA. Endocrine neoplasms of the pancreas. In: Yamada T, editor. Textbook of Gastroenterology. Philadelphia: JB Lippincott; 2003. p. 2108-46.
8. Warshaw AL, Rattner DW, Fernández del Castillo C, Z'Graggen K. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 1998; 133(3):327-31.
9. Wiedenmann B, Jensen RT, Mignon M, Modlin CI, Skogseid B, Doherty G, et al. Preoperative diagnosis and surgical management of neuroendocrine gastroenteropancreatic tumors: general recommendations by a consensus workshop. World J Surg 1998; 22(3):309-18.
10. Norton JA, Fraker DL, Alexander HR, Venzon DJ, Doppman JL, Serrano J, et al. Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med 1999; 341(9):635-44.
11. Assalia A, Gagner M. Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg 2004; 28(12):1239-47.
12. Fernández Cruz L, Martínez I, César Borges G, Astudillo E, Orduna D, Halperin I, et al. Laparoscopic surgery in patients with sporadic and multiple insulinomas associated with multiple endocrine neoplasia type 1. J Gastrointest Surg 2005; 9(3):381-8.
13. Fernández Cruz L, César Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg 2006; 10(5):752-60.
14. Phan GQ, Yeo CJ, Hruban RH, Lillemoe KD, Pitt HA, Cameron JL. Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg 1998; 2(5):472-82.
15. Ardengh JC, Rosenbaum P, Ganc AJ, Goldenberg A, Lobo EJ, Malheiros CA, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc 2000; 51(5):552-5.
16. Ardengh JC, Valiati LH, Geocze S. Identification of insulinomas by endoscopic ultrasonography. Rev Assoc Med Bras 2004; 50(2):167-71.
17. Ardengh JC, Ferrari A. Tissue diagnosis of pancreatic lesions by endosonography guided fine-needle aspiration. Hepato-gastroenterology 1998; 45(II):418-21.
18. Kloppel G, Heitz PU. Pancreatic endocrine tumors. Pathol Res Pract 1988; 183(2):155-68.
19. Ardengh JC, De Paulo GA, Ferrari AP. EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery. Gastrointest Endosc 2004; 60(3):378-84.
20. Alexander RA, Jensen RT. Pancreatic endocrine tumors. In: de Vita VT, Hellman S, Rosenberg SA, editors. Cancer. Principles and practice of oncology. 6a ed. Philadelphia: J B Lippincott; 2001. p. 1788.
21. Wynick D, Williams SJ, Bloom SR. Symptomatic secondary hormone syndromes in patients with established malignant pancreatic endocrine tumors. N Engl J Med 1988; 319(10):605-7.
22. Modlin IM, Tang LH. Approaches to the diagnosis of gut neuroendocrine tumors: the last word (today). Gastroenterology 1997; 112(2):583-90.
23. Mignon M. Natural history of neuroendocrine enteropancreatic tumors. Digestion 2000; 62 Suppl 1:51-8.
24. Boden G. Glucagonomas and insulinomas. Gastroenterol Clin North Am 1989; 18(4):831-45.
25. Norton JA, Levin B, Jensen RT. Cancer of the endocrine system. In: T. DVV, Hellman S, Resenberg AS, editors. Cancer Principles and Practice of Oncology. Phipladelphie: J B Lippincott; 1995. p. 1333-1435.
26. Finlayson E, Clark OH. Surgical treatment of insulinomas. Surg Clin North Am 2004; 84(3):775-85.
27. Palazzo L, Roseau G, Chaussade S, Salmeron M, Gaudric M, Paolaggi JA. Pancreatic endocrine tumors: contribution of ultrasound endoscopy in the diagnosis of localization. Ann Chir 1993; 47(5):419-24.
28. Gibril F, Reynolds JC, Doppman JL, Chen CC, Venzon DJ, Termanini B, et al. Somatostatin receptor scintigraphy: its sensitivity compared with that of other imaging methods in detecting primary and metastatic gastrinomas. A prospective study. Ann Intern Med 1996; 125(1):26-34.
29. Zimmer T, Stolzel U, Bader M, Koppenhagen K, Hamm B, Buhr H, et al. Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 1996; 39(4):562-8.
30. Gibril F, Jensen RT. Comparative analysis of diagnostic techniques for localization of gastrointestinal neuroendocrine tumors. Yale J Biol Med 1997; 70(5-6):509-22.
31. De Angelis C, Repici A, Arena V, Pellicano R, Rizzetto M. Preoperative endoscopic ultrasonography in decision making and management for pancreatic endocrine tumors: a 6-year experience. Endoscopy 1998; 30 Suppl 1:A182-6.
32. De Angelis C, Carucci P, Repici A, Rizzetto M. Endosonography in decision making and management of gastrointestinal endocrine tumors. Eur J Ultrasound 1999; 10(2-3):139-50.
33. Fendrich V, Bartsch DK, Langer P, Zielke A, Rothmund M. Diagnosis and surgical treatment of insulinoma--experiences in 40 cases. Dtsch Med Wochenschr 2004; 129(17):941-6.
34. Hellman P, Hennings J, Akerstrom G, Skogseid B. Endoscopic ultrasonography for evaluation of pancreatic tumours in multiple endocrine neoplasia type 1. Br J Surg 2005; 92(12):1508-12.
35. Chiti A, Fanti S, Savelli G, Romeo A, Bellanova B, Rodari M, et al. Comparison of somatostatin receptor imaging, computed tomography and ultrasound in the clinical management of neuroendocrine gastro-entero-pancreatic tumours. Eur J Nucl Med 1998; 25(10):1396-403.
36. Rickes S, Unkrodt K, Ocran K, Neye H, Wermke W. Differentiation of neuroendocrine tumors from other pancreatic lesions by echo-enhanced power Doppler sonography and somatostatin receptor scintigraphy. Pancreas 2003; 26(1):76-81.
37. Kirchhoff TD, Merkesdal S, Frericks B, Brabant G, Scheumann G, Galanski M, et al. Intraarterial calcium stimulation (ASVS) for pancreatic insulinoma: comparison of preoperative localization procedures. Radiologe 2003; 43(4):301-5.
38. Kaczirek K, Ba-Ssalamah A, Schima W, Niederle B. The importance of preoperative localisation procedures in organic hyperinsulinism--experience in 67 patients. Wien Klin Wochenschr 2004; 116(11-12):373-8.
39. Nikou GC, Lygidakis NJ, Toubanakis C, Pavlatos S, Tseleni-Balafouta S, Giannatou E, et al. Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum chromogranin-A, somatostatin receptor scintigraphy and somatostatin analogues. Hepatogastroenterology 2005; 52(63):731-41.
40. Gouya H, Vignaux O, Augui J, Dousset B, Palazzo L, Louvel A, et al. CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am J Roentgenol 2003; 181(4):987-92.
41. Rappeport ED, Hansen CP, Kjaer A, Knigge U. Multidetector computed tomography and neuroendocrine pancreaticoduodenal tumors. Acta Radiol 2006; 47(3):248-56.
42. Zimmer T, Ziegler K, Bader M, Fett U, Hamm B, Riecken EO, et al. Localisation of neuroendocrine tumours of the upper gastrointestinal tract. Gut 1994; 35(4):471-5.
43. Thoeni RF, Mueller-Lisse UG, Chan R, Do NK, Shyn PB. Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity. Radiology 2000; 214(2):483-90.
44. Brandle M, Pfammatter T, Spinas GA, Lehmann R, Schmid C. Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours. Clin Endocrinol (Oxf) 2001; 55(3):357-62.
45. Van Eijck CH, Lamberts SW, Lemaire LC, Jeekel H, Bosman FT, Reubi JC, et al. The use of somatostatin receptor scintigraphy in the differential diagnosis of pancreatic duct cancers and islet cell tumors. Ann Surg 1996; 224(2):119-24.
46. Saga T, Shimatsu A, Koizumi K, Ichikawa T, Yamamoto K, Noguchi S, et al. Morphological imaging in the localization of neuroendocrine gastroenteropancreatic tumors found by somatostatin receptor scintigraphy. Acta Radiol 2005; 46(3):227-32.
47. Mirallie E, Pattou F, Malvaux P, Filoche B, Godchaux JM, Maunoury V, et al. Value of endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localization of insulinomas and gastrinomas. Experience of 54 cases. Gastroenterol Clin Biol 2002; 26(4):360-6.
48. Jensen RT, Gibril F, Termanini B. Definition of the role of somatostatin receptor scintigraphy in gastrointestinal neuroendocrine tumor localization. Yale J Biol Med 1997; 70(5-6):481-500.
49. Kumbasar B, Kamel IR, Tekes A, Eng J, Fishman EK, Wahl RL. Imaging of neuroendocrine tumors: accuracy of helical CT versus SRS. Abdom Imaging 2004; 29(6):696-702.
50. Galiber AK, Reading CC, Charboneau JW, Sheedy PF, 2nd, James EM, Gorman B, et al. Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography. Radiology 1988; 166(2):405-8.
51. Krenning EP, Kwekkeboom DJ, Oei HY, de Jong RJ, Dop FJ, Reubi JC, et al. Somatostatin-receptor scintigraphy in gastroenteropancreatic tumors. An overview of European results. Ann N Y Acad Sci 1994; 733:416-24.
52. Collins BT, Saeed ZA. Fine needle aspiration biopsy of pancreatic endocrine neoplasms by endoscopic ultrasonographic guidance. Acta Cytol 2001; 45(5):905-7.
53. Jhala D, Eloubeidi M, Chhieng DC, Frost A, Eltoum IA, Roberson JJ, et al. Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy. Ann Diagn Pathol 2002; 6(2):106-12.
54. Stelow EB, Woon C, Pambuccian SE, Thrall M, Stanley MW, Lai R, et al. Fine-needle aspiration cytology of pancreatic somatostatinoma: the importance of immunohistochemistry for the cytologic diagnosis of pancreatic endocrine neoplasms. Diagn Cytopathol 2005; 33(2):100-5.
55. Wamsteker EJ, Gauger PG, Thompson NW, Scheiman JM. EUS detection of pancreatic endocrine tumors in asymptomatic patients with type 1 multiple endocrine neoplasia. Gastrointest Endosc 2003; 58(4):531-5.
56. Rosch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV, Jr., Yasuda K, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 1992; 326(26):1721-6.
57. Palazzo L, Roseau G, Salmeron M. Endoscopic ultrasonography in the preoperative localization of pancreatic endocrine tumors. Endoscopy 1992; 24 Suppl 1:350-3.
58. Cadiot G, Lebtahi R, Sarda L, Bonnaud G, Marmuse JP, Vissuzaine C, et al. Preoperative detection of duodenal gastrinomas and peripancreatic lymph nodes by somatostatin receptor scintigraphy. Groupe D'etude Du Syndrome De Zollinger-Ellison. Gastroenterology 1996; 111(4):845-54.
59. Schumacher B, Lubke HJ, Frieling T, Strohmeyer G, Starke AA. Prospective study on the detection of insulinomas by endoscopic ultrasonography. Endoscopy 1996; 28(3):273-6.
60. Gress FG, Barawi M, Kim D, Grendell JH. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest Endosc 2002; 55(4):594-7.
61. Fritscher-Ravens A, Izbicki JR, Sriram PV, Krause C, Knoefel WT, Topalidis T, et al. Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery. Am J Gastroenterol 2000; 95(9):2255-60.
62. Fritscher-Ravens A, Brand L, Knofel WT, Bobrowski C, Topalidis T, Thonke F, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002; 97(11):2768-75.
63. Arcidiacono PG, Giovannini M, Bergel C, Monges G, Ardengh JC, Guaraldi S, et al. Results of a multicentric study on EUS-FNA of pancreatic tumors of less than 3,0 cm in diameter. Gastrointest Endosc 2005; 61(5):AB 270.
64. Voss M, Hammel P, Molas G, Palazzo L, Dancour A, O'Toole D, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut 2000; 46(2):244-9.
65. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol 2000; 95(9):2271-7.
66. Gines A, Vázquez Sequeiros E, Soria MT, Clain JE, Wiersema MJ. Usefulness of EUS-guided fine needle aspiration (EUS-FNA) in the diagnosis of functioning neuroendocrine tumors. Gastrointest Endosc 2002; 56(2):291-6.
67. Bansal R, Tierney W, Carpenter S, Thompson N, Scheiman JM. Cost effectiveness of EUS for preoperative localization of pancreatic endocrine tumors. Gastrointest Endosc 1999; 49(1):19-25.
68. Harewood GC, Wiersema LM, Halling AC, Keeney GL, Salamao DR, Wiersema MJ. Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses. Gastrointest Endosc 2002; 55(6):669-73.
69. Mertz H, Gautam S. The learning curve for EUS-guided FNA of pancreatic cancer. Gastrointest Endosc 2004; 59(1):33-7.
70. Fidler JL, Fletcher JG, Reading CC, Andrews JC, Thompson GB, Grant CS, et al. Preoperative detection of pancreatic insulinomas on multiphasic helical CT. AJR Am J Roentgenol 2003; 181(3):775-80.
71. Thomas-Marques L, Murat A, Delemer B, Penfornis A, Cardot-Bauters C, Baudin E, et al. Prospective endoscopic ultrasonographic evaluation of the frequency of nonfunctioning pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1. Am J Gastroenterol 2006; 101(2):266-73.
 
 
 
 
 
 
 
 
 
 
 
 
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