Top

Published in:

01-01-2021 | Ultrasound | New Technology

EUS-guided fine needle tattooing (EUS-FNT) for preoperative localization of small pancreatic neuroendocrine tumors (p-NETs): a single-center experience

Authors: Fausto Rosa, Mihai Rimbaș, Gianenrico Rizzatti, Giuseppe Quero, Claudio Fiorillo, Michele Impagnatiello, Francesca D’Aversa, Guido Costamagna, Sergio Alfieri, Alberto Larghi

Published in: Surgical Endoscopy | Issue 1/2021

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 intra-operative 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 EUS-FNA 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.

O'Grady HL, Conlon KC (2008) Pancreatic neuroendocrine tumours. Eur J Surg Oncol 34:324–332CrossRef

Farrell JJ, Sherrod A, Parekh D (2009) EUS-guided fine-needle tattooing for preoperative localization of early pancreatic adenocarcinoma. Gastrointest Endosc 69:176–177CrossRef

Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054CrossRef

Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137CrossRef

Hu M, Zhao G, Luo Y, Liu R (2011) Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases. Surg Endosc 25:3831–3837CrossRef

Jaroszewski DE, Schlinkert RT, Thompson GB, Schlinkert DK (2004) Laparoscopic localization and resection of insulinomas. Arch Surg 139:270–274CrossRef

Ayav A, Bresler L, Brunaud L et al (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390:134–140CrossRef

Fasanella KE, McGrath KM, Sanders M, Brody D, Domsic R, Khalid A (2009) Pancreatic endocrine tumor EUS-guided FNA DNA microsatellite loss and mortality. Gastrointest Endosc 69:1074–1080CrossRef

Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM (2000) Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol 95:2271–2277CrossRef

10.

Leeds JS, Nayar MK, Bekkali NLH, Wilson CH, Johnson SJ, Haugk B, Darne A, Oppong KW (2019) Endoscopic ultrasound-guided fine-needle biopsy is superior to fine-needle aspiration in assessing pancreatic neuroendocrine tumors. Endosc Int Open 7:E1281–E1287CrossRef

11.

Eusebi LH, Thorburn D, Toumpanakis C, Frazzoni L, Johnson G, Vessal S, Luong TV, Caplin M, Pereira SP (2019) Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors. Endosc Int Open 7:E1393–E1399CrossRef

12.

Larghi A, Capurso G, Carnuccio A, Ricci R, Alfieri S, Galasso D, Lugli F, Bianchi A, Panzuto F, De Marinis L, Falconi M, Delle Fave G, Doglietto GB, Costamagna G, Rindi G (2012) Ki-67 grading of nonfunctioning pancreatic neuroendocrine tumors on histologic samples obtained by EUS-guided fine-needle tissue acquisition: a prospective study. Gastrointest Endosc 76:570–577CrossRef

13.

Gleeson FC, Levy MJ (2011) Endoscopic ultrasound. Endoscopy 43:54–57CrossRef

14.

Ashida R, Yamao K, Okubo K, Sawaki A, Mizuno N, Nakamura T, Tajika M, Kawai H, Shimizu Y (2006) Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy 38:190–192CrossRef

15.

Larsen MH, Fristrup CW, Mortensen MB (2009) Endoscopic ultrasound-guided fine-needle marking of a small pancreatic tumor. Endoscopy 41(Suppl 2):E175–E176CrossRef

16.

Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, VC Conference participants (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103:153–171CrossRef

17.

Rimbaş M, Horumbă M, Rizzatti G, Crinò SF, Gasbarrini A, Costamagna G, Larghi A (2020) Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms. Dig Endosc. https://doi.org/10.1111/den.13635CrossRefPubMed

18.

Rösch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV Jr, Yasuda K, Heyder N, Palazzo L, Dancygier H, Schusdziarra V, Classen M (1992) Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 326:1721–1726CrossRef

19.

Kann PH (2018) Is endoscopic ultrasonography more sensitive than magnetic resonance imaging in detecting and localizing pancreatic neuroendocrine tumors? Rev Endocr Metab Disord 19:133–137CrossRef

20.

Sallinen VJ, Le Large TYS, Tieftrunk E, Galeev S, Kovalenko Z, Haugvik SP, Antila A, Franklin O, Martinez-Moneo E, Robinson SM, Panzuto F, Regenet N, Muffatti F, Partelli S, Wiese D, Ruszniewski P, Dousset B, Edwin B, Bartsch DK, Sauvanet A, Falconi M, Ceyhan GO, Gaujoux S, Pancreas (2000) research group (2008) Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors—a multi-institutional study. HPB 20:251–259CrossRef

21.

Gress FG, Barawi M, Kim D, Grendell JH (2002) Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest Endosc 55:594–597CrossRef

22.

Zografos GN, Stathopoulou A, Mitropapas G, Karoubalis J, Kontogeorgos G, Kaltsas G, Piaditis G, Papastratis GI (2005) Preoperative imaging and localization of small sized insulinoma with EUS-guided fine needle tattoing: a case report. Hormones 4:111–116PubMed

23.

Rodriguez A, Canto MI, Makary MA (2011) Endoscopic localization and tattooing of a proinsulinoma for minimally invasive resection. Pancreas 40:474–477CrossRef

24.

Leelasinjaroen P, Manatsathit W, Berri R, Barawi M, Gress FG (2014) Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma. World J Gastrointest Endosc 6:506–509CrossRef

25.

Okuzono T, Kanno Y, Nakahori M, Aoki H, Sato S, Matsuda T, Chonan A (2016) Preoperative endoscopic ultrasonography-guided tattooing of the pancreas with a minuscule amount of marking solution using a newly designed injector. Dig Endosc 28:744–748CrossRef

26.

Jani N, Khalid A, Kaushik N, Brody D, Bauer K, Schoedel K, Ohori NP, Moser AJ, Lee K, McGrath K (2008) EUS-guided FNA diagnosis of pancreatic endocrine tumors: new trends identified. Gastrointest Endosc 67:44–50CrossRef

27.

Newman NA, Lennon AM, Edil BH, Gilson MM, Giday SA, Canto MI, Schulick RD, Makary MA (2010) Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal pancreatectomy. Surgery 148:371–377CrossRef

28.

Sato N, Takano S, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, Suzuki D, Sakai N, Kagawa S, Mishima T, Nakadai E, Mikata R, Kato N, Ohtsuka M (2020) Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review. BMC Gastroenterol. https://doi.org/10.1186/s12876-020-1159-xCrossRefPubMedPubMedCentral

Title: EUS-guided fine needle tattooing (EUS-FNT) for preoperative localization of small pancreatic neuroendocrine tumors (p-NETs): a single-center experience
Authors: Fausto Rosa
Mihai Rimbaș
Gianenrico Rizzatti
Giuseppe Quero
Claudio Fiorillo
Michele Impagnatiello
Francesca D’Aversa
Guido Costamagna
Sergio Alfieri
Alberto Larghi
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Ultrasound
Pancreatectomy
Insulinoma
Insulinoma
Ultrasound
Neuroendocrine Tumor
Published in: Surgical Endoscopy / Issue 1/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07996-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

EUS-guided fine needle tattooing (EUS-FNT) for preoperative localization of small pancreatic neuroendocrine tumors (p-NETs): a single-center experience

Abstract

Background

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Predictive factors of post-laparoscopic inguinal hernia acute and chronic pain: prospective follow-up of 807 patients from a single experienced surgeon

Outcomes after distal pancreatectomy for neuroendocrine neoplasms: a retrospective comparison between minimally invasive and open approach using propensity score weighting

Abdominal core quality of life after ventral hernia repair: a comparison of open versus robotic-assisted retromuscular techniques

Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases

Development and validation of machine learning models to predict gastrointestinal leak and venous thromboembolism after weight loss surgery: an analysis of the MBSAQIP database

Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes