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- Title
The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors.
- Authors
Furnari, Manuele; Buda, Andrea; Delconte, Gabriele; Citterio, Davide; Voiosu, Theodor; Ballardini, Giovanni; Cavallaro, Flaminia; Savarino, Edoardo; Mazzaferro, Vincenzo; Meroni, Emanuele
- Abstract
Background & 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 wirelesscapsule 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 tumor in patients showing liver NET metastases when first-line investigations are inconclusive. Method: Twenty-four patients with 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. Minilaparotomy 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.
- Subjects
NEUROENDOCRINE tumors; CAPSULE endoscopy; ABDOMINAL surgery; GASTROINTESTINAL tumors treatment; DIAGNOSTIC ultrasonic imaging; DIAGNOSIS
- Publication
Journal of Gastrointestinal & Liver Diseases, 2017, Vol 26, Issue 2, p151
- ISSN
1841-8724
- Publication type
Article
- DOI
10.15403/jgld.2014.1121.262.wce