Session: MON 292-305-MEN1, MEN2 & Pheochromocytomas
Poster Board MON-302
Patients and methods: We conducted a cross sectional study in 22 patients in a tertiary care university medical center. Patients with a germline VHL mutation or with one VHL-manifestation and mutation carrier as 1st grade family member, with screening by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) within 4 months and somatostatin receptor scintigraphy (SRS) within 6 months, were eligible. Patients underwent 11C-5-HTP PET and linear EUS with the possibility to obtain cell material by EUS-guided fine needle aspiration (FNA). For all imaging techniques, positivity of pancreatic solid lesions was calculated at the level of individual patients and of individual lesions. The sum of positives of all imaging served as a composite reference standard. EUS and 11C-5-HTP PET were compared with standard screening using Mc Nemar’s test for comparison.
Results: In 10 patients (45%), 20 pancreatic solid lesions were detected with a median size of 9.0 mm (range 2.9-55). Seventeen solid lesions were detected with EUS (P < 0.05 versus CT/MRI+ SRS) in 10 patients, 3 with 11C-5-HTP PET (P = 0.11 versus CT/MRI+ SRS) in one patient, 3 with SRS in three patients, 9 with CT/MRI in seven patients and 9 with CT/MRI+ SRS in seven patients. Next to solid lesions, EUS found in 18 patients multiple pancreatic cysts with a median of 4 cysts (range 1-30) per patient. FNA was performed in 7 solid lesions with a median of 2 passes (range 2-6). In 2 lesions (29%), tumor cells were detected. The remaining samples did not yield enough cells for a diagnosis.
Conclusion: EUS is superior to CT/MRI+ SRS to detect pancreatic solid lesions in VHL disease. In this setting 11C-5-HTP PET is of no value. For confirmation of diagnosis by EUS-guided FNA, improvement of cell yield is warranted and needs further research.
Nothing to Disclose: SJV, AHB, HMV, EJV, AHB, IPK, KPK, BAZ, HJT, WWD, WJS, EGD, TPL
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