The role of wireless capsule endoscopy (WCE) in the detection of occult primary neuroendocrine tumors.
- Furnari M Department of Internal Medicine, Gastroenterology Unit, IRCCS, University of Genoa, Italy. manuelefurnari@gmail.com.
- Buda A Gastroenterology Unit, Santa Maria Del Parato Hospital, Feltre, Italy.
- Delconte G Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori,Milan, Italy.
- Citterio D Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
- Voiosu T Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
- Ballardini G Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
- Cavallaro F Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori,Milan, Italy.
- Savarino E Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Italy.
- Mazzaferro V Department of Surgery, Endoscopy and Gastrointestinal Surgery Units, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
- Meroni E Regional Hospital Beata Vergine, EOC, Mendrisio, Switzerland.
- 2017-06-16
Published in:
- Journal of gastrointestinal and liver diseases : JGLD. - 2017
Adult
Aged
Bile Duct Neoplasms
Biopsy
Capsule Endoscopy
Female
Humans
Intestinal Neoplasms
Liver Neoplasms
Male
Middle Aged
Neoplasms, Unknown Primary
Neuroendocrine Tumors
Pancreatic Neoplasms
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Unnecessary Procedures
English
BACKGROUND AND AIMS
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive.
METHOD
Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.
RESULTS
Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.
CONCLUSIONS
Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive.
METHOD
Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.
RESULTS
Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.
CONCLUSIONS
Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.15403/jgld.2014.1121.262.wce
- PMID 28617885
- Persistent URL
- https://sonar.ch/global/documents/177469
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