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Tu1684 Clinical Significance of Incidental Pancreatic Neuroendocrine Tumors (I-PNET) Diagnosed by Endoscopic Ultrasound (EUS)
Abstracts
Tu1683 Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Lesions: Adverse Event Rate and Risk Factors At a Tertiary Academic Medical Center Michael Weaver*1, Kara Regan2, Dayna S. Early2, Steven A. Edmundowicz2, Faris Murad2, Daniel Mullady2, Riad R. Azar2, Vladimir M. Kushnir2 1 Internal Medicine, Barnes-Jewish Hospital/Washington University in St. Louis, Saint Louis, MO; 2Gastroenterology, Barnes-Jewish Hospital/ Washington University in St. Louis, Saint Louis, MO Background: Endoscopic ultrasound fine needle aspiration (EUS-FNA) is used frequently to diagnose pancreatic lesions. Despite the utilization of this practice, the relationship of pancreatic lesion characteristics, EUS-FNA techniques and risk of adverse events is incompletely understood. Aims: Evaluate the 1) incidence of and 2) risk factors for adverse events following EUS-FNA of solid pancreatic lesions. Methods: Consecutive patients undergoing EUS-FNA of a solid pancreatic lesion at a single tertiary care center between 2011 and 2013 were identified for inclusion in this retrospective cohort study. Patients were excluded if they underwent endoscopic retrograde cholangiopancreatography or celiac plexus block on the same day as EUS-FNA. Patient demographics, pancreatic lesion characteristics, and FNA techniques were recorded. Presence or absence of adverse events was ascertained retrospectively by the investigators. Results: A total of 691 pancreatic EUS-FNA were completed over three years. The mean patient age was 64.112.3 years and 338 (48.9%) were female. Adverse events occurred following 36 (5.2%) procedures and included acute pancreatitis (nZ10,1.4%), sepsis (nZ5,0.7%), bleeding requiring transfusion intervention (nZ4,0.6%), worsened biliary obstruction cholangitis in patients with evidence of biliary obstruction or existing biliary stent in place (nZ3, 0.4%), and abdominal pain requiring hospital admission (nZ14, 2%). Patients who developed adverse events were younger than those who did not (58.512.9 vs 64.512.2 years old, pZ0.005). None of the other recorded demographic, clinical or procedural characteristics were associated with post FNA adverse events (Table 1). Conclusions: EUS-FNA of pancreatic lesions appears to be a safe technique, offering a low risk of overall AEs (5.2%). With the exception of patient age, the characteristics of the pancreatic lesion, endoscopic technique and patient demographics did not significantly increase the risk of AEs.
Tu1684 Clinical Significance of Incidental Pancreatic Neuroendocrine Tumors (I-PNET) Diagnosed by Endoscopic Ultrasound (EUS) Khanh Le*2, Rick Selby1, Phuong T. Nguyen3 1 Surgery, University of Southern California, Los Angeles, CA; 2University of California Los Angeles, Los Angeles, CA; 3Gastroenterology, Hoag Hospital, Newport Beach, CA Introduction: EUS has high diagnostic accuracy for pancreatic tumors, particularly small lesions. I-pNET is defined as a pNET not previously diagnosed but detected by EUS. One prior study reports the rate of detection of I-pNETs on EUS; however, no prior study reports the clinical outcome of patients with I-pNETs detected by EUS. Aim: Report clinical significance of I-pNET’s. Methods: We retrospectively evaluated 5003 patients who underwent upper EUS exams from 01/07 to 07/14, for a variety of indications. All patients had a complete pancreatic exam. The patients were followed longitudinally to establish the natural history of I-pNET.Endpoints: 1) Frequency of I-pNET, 2) Cytology spectrum and size ranges of I-pNET, 3) Natural history of unresected I-pNET. Results: Fifty-eight patients were diagnosed with pNET by EUS-fine needle aspiration (FNA). Of these, 21 patients with I-pNET were found, without a prior imaging study (5) or without a known pancreatic lesion on CT and/or MRI (16). All I-pNET were solitary lesions. All I-pNETs had EUS-FNA cytology, characterized as well-differentiated (14) or un-characterized (7). Of the 16 patients with a prior imaging study, the mean age was 65 (range 44-75), 7M/9F. The I-pNETs were seen in the pancreas head/neck (nZ6) and body/tail (nZ10), mean size 0.6 cm (range 0.3 to 1.6 cm). Six of these 16 patients had surgery. All 10 patients with unresected I-pNET had follow-up (mean 25 mo, range 1-89 mo) by EUS (8) and other clinical follow-up (2). In 5 of 8 patients who had EUS follow-up, the lesions remained stable and in the remainder, there were !3 mm changes. Conclusion: 1. I-pNETs were detected by EUS-FNA in 0.42% of patients. 2. The majority of the patients had small, well-differentiated tumors. 3. Of the patients who did not have surgery, clinical follow-up showed stability, without progression of disease. Future prospective analysis may assess the need for surgical resection of these lesions.
Tu1685 Diagnostic Yield of EUS-Guided FNA for Malignant Biliary Stricture: a Systematic Review and Meta-Analysis Mehdi Mohamadnejad*1, Anahita Sadeghi1, Farhad Islami2, Mohammad Biglari1, Abbas Keshtkar1, Reza Malekzadeh1, Mohamad A. Eloubeidi3 1 Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of); 2American Cancer Society, Atlanta, GA; 3American University of Beirut, Beirut, Lebanon Introduction: EUS-guided fine needle aspiration (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary striuctures. There is a significant variability in the reported sensitivity of EUS-FNA in biliary strictures across different studies. Here, we performed the first structured meta-analysis of all relevant studies to determine the diagnostic utility of EUS-FNA in malignant biliary stricture. Methods: A comprehensive search of the literature up to June 2014 was performed by two reviewers for studies investigating the utility of EUS-FNA for detection of malignancy in biliary strictures. Meta-analysis for the accuracy of EUS-FNA in biliary strictures was performed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and the diagnostic odds ratio.QUADAS-2 questionnaire was used to assess the quality of the selected studies. Meta-regression analysis was performed to assess whether the qualities of any single study was incurring undue weight in the analysis. Results: A comprehensive literature search generated 330 articles. The titles and abstracts of these were reviewed in accordance to the predefined exclusion criteria, yielding 125 potentially relevant articles that were reviewed in depth. Among these, 20 studies (957 patients) were included in final analysis. Sixteen studies were published as full text in peer-reviewed journals, and four studies were published as abstract in major gastroenterology conferences. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% CI, 74%0.86%), and 97% (95% CI, 94%-99%) respectively. The pooled positive predictive value was 99% (95% CI, 98%-100%), and the pooled negative predictive value was 60% (95% CI, 55%-65%). The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the pooled negative likelihood ratio was 0.26 (95% CI, 0.180.38).The pooled diagnostic odds ratio was 70.53 (95% CI, 38.62-128.82). The area under the receiver operating characteristic curve was 0.97.In the next step, we calculated the diagnostic accuracies of EUS-FNA for distal and proximal biliary strictures separately.Nine studies (294 patients) reported sensitivity of EUS-FNA in proximal biliary strictures, while four studies (158 patients) reported the diagnostic value of EUS-FNA in distal biliary strictures.The pooled sensitivity of EUS-FNA for distal and proximal biliary strictures were 83% (95% CI, 68%-98%), and 76% (95% CI, 66%-85%), respectively.Meta-regression analysis revealed that the qualities of the studies did not affect the accuracies of the final results of meta-analysis (PO0.05 for both sensitivity and specificity). Conclusion: EUS-FNA has a good sensitivity and excellent specificity to diagnose malignancy in biliary strictures. Its sensitivity is higher in distal than in proximal biliary strictures.
AB558 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
www.giejournal.org
Tu1683 Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Lesions: Adverse Event Rate and Risk Factors At a Tertiary Academic Medical Center Michael Weaver*1, Kara Regan2, Dayna S. Early2, Steven A. Edmundowicz2, Faris Murad2, Daniel Mullady2, Riad R. Azar2, Vladimir M. Kushnir2 1 Internal Medicine, Barnes-Jewish Hospital/Washington University in St. Louis, Saint Louis, MO; 2Gastroenterology, Barnes-Jewish Hospital/ Washington University in St. Louis, Saint Louis, MO Background: Endoscopic ultrasound fine needle aspiration (EUS-FNA) is used frequently to diagnose pancreatic lesions. Despite the utilization of this practice, the relationship of pancreatic lesion characteristics, EUS-FNA techniques and risk of adverse events is incompletely understood. Aims: Evaluate the 1) incidence of and 2) risk factors for adverse events following EUS-FNA of solid pancreatic lesions. Methods: Consecutive patients undergoing EUS-FNA of a solid pancreatic lesion at a single tertiary care center between 2011 and 2013 were identified for inclusion in this retrospective cohort study. Patients were excluded if they underwent endoscopic retrograde cholangiopancreatography or celiac plexus block on the same day as EUS-FNA. Patient demographics, pancreatic lesion characteristics, and FNA techniques were recorded. Presence or absence of adverse events was ascertained retrospectively by the investigators. Results: A total of 691 pancreatic EUS-FNA were completed over three years. The mean patient age was 64.112.3 years and 338 (48.9%) were female. Adverse events occurred following 36 (5.2%) procedures and included acute pancreatitis (nZ10,1.4%), sepsis (nZ5,0.7%), bleeding requiring transfusion intervention (nZ4,0.6%), worsened biliary obstruction cholangitis in patients with evidence of biliary obstruction or existing biliary stent in place (nZ3, 0.4%), and abdominal pain requiring hospital admission (nZ14, 2%). Patients who developed adverse events were younger than those who did not (58.512.9 vs 64.512.2 years old, pZ0.005). None of the other recorded demographic, clinical or procedural characteristics were associated with post FNA adverse events (Table 1). Conclusions: EUS-FNA of pancreatic lesions appears to be a safe technique, offering a low risk of overall AEs (5.2%). With the exception of patient age, the characteristics of the pancreatic lesion, endoscopic technique and patient demographics did not significantly increase the risk of AEs.
Tu1684 Clinical Significance of Incidental Pancreatic Neuroendocrine Tumors (I-PNET) Diagnosed by Endoscopic Ultrasound (EUS) Khanh Le*2, Rick Selby1, Phuong T. Nguyen3 1 Surgery, University of Southern California, Los Angeles, CA; 2University of California Los Angeles, Los Angeles, CA; 3Gastroenterology, Hoag Hospital, Newport Beach, CA Introduction: EUS has high diagnostic accuracy for pancreatic tumors, particularly small lesions. I-pNET is defined as a pNET not previously diagnosed but detected by EUS. One prior study reports the rate of detection of I-pNETs on EUS; however, no prior study reports the clinical outcome of patients with I-pNETs detected by EUS. Aim: Report clinical significance of I-pNET’s. Methods: We retrospectively evaluated 5003 patients who underwent upper EUS exams from 01/07 to 07/14, for a variety of indications. All patients had a complete pancreatic exam. The patients were followed longitudinally to establish the natural history of I-pNET.Endpoints: 1) Frequency of I-pNET, 2) Cytology spectrum and size ranges of I-pNET, 3) Natural history of unresected I-pNET. Results: Fifty-eight patients were diagnosed with pNET by EUS-fine needle aspiration (FNA). Of these, 21 patients with I-pNET were found, without a prior imaging study (5) or without a known pancreatic lesion on CT and/or MRI (16). All I-pNET were solitary lesions. All I-pNETs had EUS-FNA cytology, characterized as well-differentiated (14) or un-characterized (7). Of the 16 patients with a prior imaging study, the mean age was 65 (range 44-75), 7M/9F. The I-pNETs were seen in the pancreas head/neck (nZ6) and body/tail (nZ10), mean size 0.6 cm (range 0.3 to 1.6 cm). Six of these 16 patients had surgery. All 10 patients with unresected I-pNET had follow-up (mean 25 mo, range 1-89 mo) by EUS (8) and other clinical follow-up (2). In 5 of 8 patients who had EUS follow-up, the lesions remained stable and in the remainder, there were !3 mm changes. Conclusion: 1. I-pNETs were detected by EUS-FNA in 0.42% of patients. 2. The majority of the patients had small, well-differentiated tumors. 3. Of the patients who did not have surgery, clinical follow-up showed stability, without progression of disease. Future prospective analysis may assess the need for surgical resection of these lesions.
Tu1685 Diagnostic Yield of EUS-Guided FNA for Malignant Biliary Stricture: a Systematic Review and Meta-Analysis Mehdi Mohamadnejad*1, Anahita Sadeghi1, Farhad Islami2, Mohammad Biglari1, Abbas Keshtkar1, Reza Malekzadeh1, Mohamad A. Eloubeidi3 1 Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of); 2American Cancer Society, Atlanta, GA; 3American University of Beirut, Beirut, Lebanon Introduction: EUS-guided fine needle aspiration (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary striuctures. There is a significant variability in the reported sensitivity of EUS-FNA in biliary strictures across different studies. Here, we performed the first structured meta-analysis of all relevant studies to determine the diagnostic utility of EUS-FNA in malignant biliary stricture. Methods: A comprehensive search of the literature up to June 2014 was performed by two reviewers for studies investigating the utility of EUS-FNA for detection of malignancy in biliary strictures. Meta-analysis for the accuracy of EUS-FNA in biliary strictures was performed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and the diagnostic odds ratio.QUADAS-2 questionnaire was used to assess the quality of the selected studies. Meta-regression analysis was performed to assess whether the qualities of any single study was incurring undue weight in the analysis. Results: A comprehensive literature search generated 330 articles. The titles and abstracts of these were reviewed in accordance to the predefined exclusion criteria, yielding 125 potentially relevant articles that were reviewed in depth. Among these, 20 studies (957 patients) were included in final analysis. Sixteen studies were published as full text in peer-reviewed journals, and four studies were published as abstract in major gastroenterology conferences. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% CI, 74%0.86%), and 97% (95% CI, 94%-99%) respectively. The pooled positive predictive value was 99% (95% CI, 98%-100%), and the pooled negative predictive value was 60% (95% CI, 55%-65%). The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the pooled negative likelihood ratio was 0.26 (95% CI, 0.180.38).The pooled diagnostic odds ratio was 70.53 (95% CI, 38.62-128.82). The area under the receiver operating characteristic curve was 0.97.In the next step, we calculated the diagnostic accuracies of EUS-FNA for distal and proximal biliary strictures separately.Nine studies (294 patients) reported sensitivity of EUS-FNA in proximal biliary strictures, while four studies (158 patients) reported the diagnostic value of EUS-FNA in distal biliary strictures.The pooled sensitivity of EUS-FNA for distal and proximal biliary strictures were 83% (95% CI, 68%-98%), and 76% (95% CI, 66%-85%), respectively.Meta-regression analysis revealed that the qualities of the studies did not affect the accuracies of the final results of meta-analysis (PO0.05 for both sensitivity and specificity). Conclusion: EUS-FNA has a good sensitivity and excellent specificity to diagnose malignancy in biliary strictures. Its sensitivity is higher in distal than in proximal biliary strictures.
AB558 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
www.giejournal.org