Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy

Anna Gallotti, Rocio Perez Johnston, Pietro A. Bonaffini, Thun Ingkakul, Vikram Deshpande, Carlos Fernandez-Del Castillo, Dushyant V. Sahani

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of "nonbenign" behavior. MATERIALS AND METHODS. In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS. A total of 32 of 60 (53%) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61% for nonbenign tumors and 100% when calcification was present. In 12 patients with recurrence, 92% of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2% on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION. Approximately 50% of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30% of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.

Original languageEnglish
Pages (from-to)355-362
Number of pages8
JournalAmerican Journal of Roentgenology
Volume200
Issue number2
DOIs
Publication statusPublished - Feb 2013

Fingerprint

Neuroendocrine Tumors
Pancreas
Recurrence
Neoplasms
Pancreatic Ducts
Incidence
Blood Vessels
Dilatation
Histology
Retrospective Studies
Lymph Nodes
Sensitivity and Specificity

Keywords

  • Incidental lesions
  • MDCT
  • Neuroendocrine tumors
  • Pancreas
  • Pancreatic malignancy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Gallotti, A., Perez Johnston, R., Bonaffini, P. A., Ingkakul, T., Deshpande, V., Fernandez-Del Castillo, C., & Sahani, D. V. (2013). Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. American Journal of Roentgenology, 200(2), 355-362. https://doi.org/10.2214/AJR.11.8037

Incidental neuroendocrine tumors of the pancreas : MDCT findings and features of malignancy. / Gallotti, Anna; Perez Johnston, Rocio; Bonaffini, Pietro A.; Ingkakul, Thun; Deshpande, Vikram; Fernandez-Del Castillo, Carlos; Sahani, Dushyant V.

In: American Journal of Roentgenology, Vol. 200, No. 2, 02.2013, p. 355-362.

Research output: Contribution to journalArticle

Gallotti, A, Perez Johnston, R, Bonaffini, PA, Ingkakul, T, Deshpande, V, Fernandez-Del Castillo, C & Sahani, DV 2013, 'Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy', American Journal of Roentgenology, vol. 200, no. 2, pp. 355-362. https://doi.org/10.2214/AJR.11.8037
Gallotti A, Perez Johnston R, Bonaffini PA, Ingkakul T, Deshpande V, Fernandez-Del Castillo C et al. Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. American Journal of Roentgenology. 2013 Feb;200(2):355-362. https://doi.org/10.2214/AJR.11.8037
Gallotti, Anna ; Perez Johnston, Rocio ; Bonaffini, Pietro A. ; Ingkakul, Thun ; Deshpande, Vikram ; Fernandez-Del Castillo, Carlos ; Sahani, Dushyant V. / Incidental neuroendocrine tumors of the pancreas : MDCT findings and features of malignancy. In: American Journal of Roentgenology. 2013 ; Vol. 200, No. 2. pp. 355-362.
@article{078410ffcecd4f048b333c84aebf909d,
title = "Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy",
abstract = "OBJECTIVE. The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of {"}nonbenign{"} behavior. MATERIALS AND METHODS. In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS. A total of 32 of 60 (53{\%}) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61{\%} for nonbenign tumors and 100{\%} when calcification was present. In 12 patients with recurrence, 92{\%} of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2{\%} on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION. Approximately 50{\%} of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30{\%} of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.",
keywords = "Incidental lesions, MDCT, Neuroendocrine tumors, Pancreas, Pancreatic malignancy",
author = "Anna Gallotti and {Perez Johnston}, Rocio and Bonaffini, {Pietro A.} and Thun Ingkakul and Vikram Deshpande and {Fernandez-Del Castillo}, Carlos and Sahani, {Dushyant V.}",
year = "2013",
month = "2",
doi = "10.2214/AJR.11.8037",
language = "English",
volume = "200",
pages = "355--362",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "2",

}

TY - JOUR

T1 - Incidental neuroendocrine tumors of the pancreas

T2 - MDCT findings and features of malignancy

AU - Gallotti, Anna

AU - Perez Johnston, Rocio

AU - Bonaffini, Pietro A.

AU - Ingkakul, Thun

AU - Deshpande, Vikram

AU - Fernandez-Del Castillo, Carlos

AU - Sahani, Dushyant V.

PY - 2013/2

Y1 - 2013/2

N2 - OBJECTIVE. The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of "nonbenign" behavior. MATERIALS AND METHODS. In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS. A total of 32 of 60 (53%) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61% for nonbenign tumors and 100% when calcification was present. In 12 patients with recurrence, 92% of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2% on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION. Approximately 50% of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30% of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.

AB - OBJECTIVE. The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of "nonbenign" behavior. MATERIALS AND METHODS. In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS. A total of 32 of 60 (53%) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61% for nonbenign tumors and 100% when calcification was present. In 12 patients with recurrence, 92% of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2% on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION. Approximately 50% of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30% of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.

KW - Incidental lesions

KW - MDCT

KW - Neuroendocrine tumors

KW - Pancreas

KW - Pancreatic malignancy

UR - http://www.scopus.com/inward/record.url?scp=84873585748&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873585748&partnerID=8YFLogxK

U2 - 10.2214/AJR.11.8037

DO - 10.2214/AJR.11.8037

M3 - Article

C2 - 23345357

AN - SCOPUS:84873585748

VL - 200

SP - 355

EP - 362

JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

IS - 2

ER -