Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

Joanna K. Law, Vikesh Singh, Mouen Khashab, Ralph H Hruban, Marcia Canto, Eun Shin, Payal Saxena, Matthew J Weiss, Timothy M. Pawlik, Christopher Wolfgang, Anne Marie O'Broin-Lennon

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3921-3926
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number10
DOIs
StatePublished - Oct 2013

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Neuroendocrine Tumors
Neoplasms
Surgical Pathology
Tertiary Healthcare
Tertiary Care Centers
Pancreatitis
Needles
Pancreas
Adenocarcinoma
Radiotherapy
Retrospective Studies
Safety

Keywords

  • Endoscopic ultrasound guidance
  • Fiducial placement
  • Parenchymal-sparing pancreatic surgery
  • Small neuroendocrine tumor

ASJC Scopus subject areas

  • Surgery

Cite this

@article{48c7cc422ce448bd813a06851fd19f26,
title = "Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery",
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.",
keywords = "Endoscopic ultrasound guidance, Fiducial placement, Parenchymal-sparing pancreatic surgery, Small neuroendocrine tumor",
author = "Law, {Joanna K.} and Vikesh Singh and Mouen Khashab and Hruban, {Ralph H} and Marcia Canto and Eun Shin and Payal Saxena and Weiss, {Matthew J} and Pawlik, {Timothy M.} and Christopher Wolfgang and O'Broin-Lennon, {Anne Marie}",
year = "2013",
month = "10",
doi = "10.1007/s00464-013-2975-7",
language = "English (US)",
volume = "27",
pages = "3921--3926",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",
number = "10",

}

TY - JOUR

T1 - Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery

AU - Law, Joanna K.

AU - Singh, Vikesh

AU - Khashab, Mouen

AU - Hruban, Ralph H

AU - Canto, Marcia

AU - Shin, Eun

AU - Saxena, Payal

AU - Weiss, Matthew J

AU - Pawlik, Timothy M.

AU - Wolfgang, Christopher

AU - O'Broin-Lennon, Anne Marie

PY - 2013/10

Y1 - 2013/10

N2 - 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.

AB - 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.

KW - Endoscopic ultrasound guidance

KW - Fiducial placement

KW - Parenchymal-sparing pancreatic surgery

KW - Small neuroendocrine tumor

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