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Hypervascular lesions of the pancreas: Think before you act.

PMID: 30509457 (view PubMed database entry)
DOI: 10.1016/j.amjsurg.2018.11.021 (read at publisher's website )

Susan M Wcislak, Zachary E Stiles, Jeremiah L Deneve, Evan S Glazer, Stephen W Behrman, Farees T Farooq, Paxton V Dickson,

BACKGROUND:The "classic" CT appearance of pancreatic neuroendocrine tumors (PNETs) is a solid, hypervascular lesion; however, non-PNET diagnoses may appear similar. In addition, some PNETs have a "non-classic" appearance. METHODS:Demographic, imaging, endoscopic ultrasound-fine needle aspiration (EUS/FNA) results, and pathology data were analyzed for patients who underwent pancreatectomy for suspected or confirmed diagnosis of PNET from our institutional database. RESULTS:Forty-three patients with a hypervascular lesion on CT had pancreatectomy for a pre-operative diagnosis of PNET. Final pathology revealed PNET in 30 (70%) and non-PNET diagnoses in 13 (30%). EUS/FNA had a sensitivity of 82% for the pre-operative diagnosis of PNET in patients with "classic" CT. Of 13 non-PNET diagnoses, 7 were benign. Among a total of 41 patients with a final diagnosis of PNET, 11 (27%) had "non-classic" CT (5 hypodense solid lesions, 3 isodense solid lesions, and 3 cystic lesions). Among these patients, EUS/FNA had a sensitivity of 100% in diagnosing PNET. CONCLUSIONS:Consideration of non-PNET diagnoses is important for patients with hypervascular lesions on CT. Appropriate pre-operative evaluation will optimize treatment plans.

Am. J. Surg. (American journal of surgery)
[2019, 218(2):362-367]

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