EUS-guided fine needle tattooing (EUS-FNT) for preoperative localization of small pancreatic neuroendocrine tumors (p-NE
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EUS‑guided fine needle tattooing (EUS‑FNT) for preoperative localization of small pancreatic neuroendocrine tumors (p‑NETs): a single‑center experience Fausto Rosa1 · Mihai Rimbaș2 · Gianenrico Rizzatti3,4 · Giuseppe Quero1 · Claudio Fiorillo1 · Michele Impagnatiello5 · Francesca D’Aversa5 · Guido Costamagna3,4 · Sergio Alfieri1 · Alberto Larghi3,4 Received: 5 May 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and study aims Pancreatic neuroendocrine tumors (pNETs) can be difficult to detect intra-operatively. The aim of this paper is to evaluate the safety and efficacy of preoperative endoscopic ultrasound guided fine needle tattooing (EUS-FNT) to facilitate intraoperative detection of pNETs. Patients and methods Sixteen patients with pNETs (8 insulinoma and 8 non-functional pancreatic neuroendocrine tumors) underwent EUS-FNT. The procedure was carried out using the conventional curvilinear EUS. Tattooing was performed by intralesional injection of 1–2 mL of Spot® ink (Spot®, GI Supply, Comp Hill, PA, US) using a standard 22 gauge EUSFNA needle. Results All identified pNETs could be tattooed in one session. The procedure was well tolerated in all patients without any complication. The time interval between tattooing and surgery was between 1 and 565 days (mean of 52 days). Nine patients underwent open and seven laparoscopic surgery. The tattooed lesions could be recognized in all but one patient. In one patient, a small hematoma secondary to the EUS-FNT was observed. Pathological examination of the resection specimen showed local R0 resection in all cases, and no interference with the specimen evaluation was encountered. Conclusions Our results suggest that EUS-guided FNT is a safe and useful method to mark preoperatively small (≤ 2 cm) pNETs. Keywords EUS · Endoscopic ultrasound · Tattoo · Pancreatic neuroendocrine tumors · pNET
* Fausto Rosa [email protected] 1
Digestive Surgery Unit, Department of Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
2
Gastroenterology and Internal Medicine Departments, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
3
Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4
Center for Endoscopic Research Therapeutics and Training, CERTT, Catholic University, Rome, Italy
5
Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Pancreatic neuroendocrine tumors (pNETs) are rare tumors, accounting for less than 1–2% of all primary malignancies of this organ [1, 2]. They are classified as functional (F-pNETs) or non-functional (NF-pNETs) depending on the presence or absence of a clinical hormonal hypersecretion syndrome. Most of the F-pNETs are small in size at the time of diagnosis, and this seems also to appl
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