Endoscopic Ultrasound (EUS)-guided Fiducial Placement Allows Localization of Small Neuroendocrine Tumors During Parenchymal-sparing Pancreatic Surgery

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2013 May 3

PMID 23636530

Citations 13

Authors

Joanna K Law

Vikesh K Singh

Mouen A Khashab

Ralph H Hruban

Marcia Irene Canto

Eun Ji Shin

Payal Saxena

Matthew J Weiss

Timothy M Pawlik

Christopher L Wolfgang

Anne Marie Lennon

Affiliations

Soon will be listed here.

Abstract

Background: Parenchymal-sparing pancreatic surgery is ideal for lesions such as small pancreatic neuroendocrine tumors (PanNET). However, precise localization of these small tumors at surgery can be difficult. The placement of fiducials under endoscopic ultrasound (EUS) guidance (EUS-F) has been used to direct stereotactic radiation therapy for pancreatic adenocarcinoma. This report describes two cases in which placement of fiducials was used to guide surgical resection. This study aimed to assess the feasibility, safety, and efficacy of using EUS-F for intraoperative localization of small PanNETs.

Methods: A retrospective study analyzed two consecutive patients with small PanNETs who underwent EUS-F followed by enucleation in a tertiary-care referral hospital. The following features were examined: technical success and complication rates of EUS-F, visibility of the fiducial at the time of surgery, and fiducial migration.

Results: In the study, EUS-F was performed for two female patients with a 7-mm and a 9-mm PanNET respectively in the uncinate process and neck of the pancreas. In both patients, EUS-F was feasible with two Visicoil fiducials (Core Oncology, Santa Barbara, CA, USA) placed either within or adjacent to the tumors using a 22-gauge Cook Echotip needle. At surgery, the fiducials were clearly visible on intraoperative ultrasound, and both the tumor and the fiducials were successfully enucleated in both cases. No complications were associated with EUS-F, and no evidence of pancreatitis was shown either clinically or on surgical pathology. This investigation had the limitations of a small single-center study.

Conclusions: For patients undergoing enucleation, EUS-F is technically feasible and safe and aids intraoperative localization of small PanNETs.

Citing Articles

Initial Application of Fluorescence Imaging for Intraoperative Localization of Small Neuroendocrine Tumors in the Pancreas: Case Report and Review of the Literature.

Xi S, Zheng X, Wang X, Jiang B, Shen Z, Wang G J Gastrointest Cancer. 2024; 56(1):23.

PMID: 39562390 PMC: 11576835. DOI: 10.1007/s12029-024-01143-2.

Diagnosis, treatment, and current concepts in the endoscopic management of gastroenteropancreatic neuroendocrine neoplasms.

Iabichino G, Di Leo M, Arena M, Rubis Passoni G, Morandi E, Turpini F World J Gastroenterol. 2022; 28(34):4943-4958.

PMID: 36160644 PMC: 9494936. DOI: 10.3748/wjg.v28.i34.4943.

Hot topics in therapeutic EUS.

Tabacelia D, Martiniuc A, Burtea D, Saftoiu A, Stroescu C Endosc Ultrasound. 2022; 11(3):153-155.

PMID: 35708368 PMC: 9258018. DOI: 10.4103/EUS-D-22-00080.

Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms.

Melita G, Pallio S, Tortora A, Crino S, Macri A, Dionigi G J Clin Med. 2021; 10(12).

PMID: 34203922 PMC: 8232656. DOI: 10.3390/jcm10122638.

EUS-guided placement of fiducial markers for image-guided radiotherapy in gastrointestinal tumors: A critical appraisal.

Carrara S, Rimbas M, Larghi A, Di Leo M, Comito T, Abi Jaoude J Endosc Ultrasound. 2021; 10(6):414-423.

PMID: 33666180 PMC: 8785666. DOI: 10.4103/EUS-D-20-00116.

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