Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

dc.contributor.authorPawlak, Katarzyna M.en
dc.contributor.authorTehami, Nadeemen
dc.contributor.authorMaher, Benen
dc.contributor.authorAsif, Shujaathen
dc.contributor.authorRawal, Krishn Kanten
dc.contributor.authorBalaban, Daniel Vasileen
dc.contributor.authorTag-Adeen, Mohammeden
dc.contributor.authorGhalim, Fahden
dc.contributor.authorAbbas, Wael A.en
dc.contributor.authorGhoneem, Elsayeden
dc.contributor.authorRagab, Khaleden
dc.contributor.authorEl-Ansary, Mahmouden
dc.contributor.authorKadir, Shanilen
dc.contributor.authorAmin, Sunilen
dc.contributor.authorSiau, Keithen
dc.contributor.authorWiechowska-Kozlowska, Annaen
dc.contributor.authorMonkemuller, Klausen
dc.contributor.authorAbdelfatah, Daliaen
dc.contributor.authorAbdellatef, Abeeren
dc.contributor.authorLakhtakia, Sundeepen
dc.contributor.authorOkasha, Hussein Hassanen
dc.description.abstractBACKGROUND: Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions. AIM: To determine the characteristic EUS features of SPN and define its role in preoperative assessment. METHODS: This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics. RESULTS: One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed. CONCLUSIONS: PN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.en
dc.description.versionPublished versionen
dc.publisherBaishideng Publishing Groupen
dc.rightsCreative Commons Attribution-NonCommercial 4.0 Internationalen
dc.subjectSolid pseudopapillary neoplasmen
dc.subjectFrantz tumoren
dc.subjectEndoscopic ultrasound featuresen
dc.subjectEUS-guided biopsyen
dc.subjectFine needle aspiration/biopsyen
dc.titleRole of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreasen
dc.title.serialWorld Journal of Gastrointestinal Endoscopyen
dc.typeArticle - Refereeden


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