National practice patterns in the use of endoscopic ultrasound biopsy for resectable Pancreatic Neuroendocrine Tumors: Insights into the role of DOTATATE PET/CT in diagnosis

Am J Surg. 2024 Sep:235:115779. doi: 10.1016/j.amjsurg.2024.115779. Epub 2024 May 23.

Abstract

Introduction: Pancreatic neuroendocrine tumors (PNETs) are typically diagnosed using endoscopic ultrasound-guided (EUS) biopsy, which can be associated with complications. Since 2016, DOTATATE PET/CT has emerged as an effective tool to localize and stage PNETs.

Methods: Patients with PNETs who underwent R0 resections were identified from the 2004-2019 National Cancer Database PUF. Joinpoint regression and multivariable logistic regression were used to analyze trends in the use of biopsy.

Results: Of 16,746 R0 resected PNET patients, 44 ​% underwent diagnostic biopsy. Joinpoint regression showed a significant increase in the use of biopsy from 2004 to 2019 (APC 1.80, p ​< ​0.001). A higher percentage of patients diagnosed after DOTATATE approval underwent biopsy compared to those diagnosed before (48 ​% vs. 42 ​%, p ​< ​0.001). Adjusted analysis showed diagnosis after 2016 was associated with increased odds of biopsy (OR ​= ​1.67, p ​< ​0.001).

Conclusions: Despite technologic advancement with DOTATATE PET/CT, there has been a significant increase in the proportion of resectable PNETs undergoing preoperative biopsy.

Keywords: DOTATATE PET/CT; Pancreatic neuroendocrine tumor; Ultrasound-guided biopsy.

MeSH terms

  • Adult
  • Aged
  • Endosonography / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuroendocrine Tumors* / diagnosis
  • Neuroendocrine Tumors* / diagnostic imaging
  • Neuroendocrine Tumors* / pathology
  • Neuroendocrine Tumors* / surgery
  • Organometallic Compounds
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / pathology
  • Pancreatic Neoplasms* / surgery
  • Positron Emission Tomography Computed Tomography* / statistics & numerical data
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Practice Patterns, Physicians'* / trends
  • Retrospective Studies
  • United States

Substances

  • Organometallic Compounds