EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1
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Background: In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (pNETs) are the leading MEN1-related cause of death. Objective: To evaluate EUS and C-11-5-hydroxytryptophan positron emission tomography (C-11-5-HTP PET), compared with the recommended screening techniques in MEN1 patients for early detection of pNETs. Design: Cross-sectional study. Setting: Tertiary-care university medical center. Patients: This study involved 41 patients with a proven MEN1 mutation or with one MEN1 manifestation and a mutation carrier as a first-degree family member, with recent screening by abdominal CT or magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS). Interventions: EUS by using a linear Pentax echoendoscope and Hitachi EUB-525 and C-11-5-HTP PET. Main Outcome Measurements: Patient-based and lesion-based positivity for pNET was calculated for all imaging techniques. The McNemar test was used to compare the yield of the 4 imaging techniques. Results: In 35 of 41 patients, 107 pancreatic lesions were detected in total. EUS detected 101 pancreatic lesions in 34 patients, C-11-5-HTP PET detected 35 lesions in 19 patients, and CT/MRI + SRS detected 32 lesions in 18 patients (P < .001). C-11-5-HTP PET performed similarly to CT/MRI + SRS and better compared with SRS only (13 lesions in 12 patients), both at a patient-based and lesion-based level (P < .05). Limitations: Single-center study. Conclusion: EUS is superior to CT/MRI + SRS for pancreatic lesion detection in patients with MEN1. In this setting, C-11-5-HTP PET is not useful. We recommend EUS as the first-choice pancreas imaging technique in patients with MEN1.