Abstract
Background
Hypervascularization is a typical feature of pancreatic neuroendocrine tumors, and
it frequently allows their recognition at imaging studies. However, the density of
microvessels in pancreatic neuroendocrine tumors changes according to their biological
behavior, and a low microvessel density is associated with higher disease aggressiveness.
The primary aim was to investigate the relationship between microvessel density and
aggressiveness of nonfunctioning pancreatic neuroendocrine tumors. The secondary aim
was to evaluate the ability of contrast-enhanced computed tomography and contrast-enhanced
endoscopic ultrasound in predicting tumor microvessel density.
Methods
The patients who underwent surgery for nonfunctioning pancreatic neuroendocrine tumors
(n = 66) with an available preoperative contrast-enhanced computed tomography (n = 39) and/or contrast-enhanced endoscopic ultrasound (n = 37) performed at San Raffaele Hospital (2016–2020) were included. The tumor vascularization
was assessed by CD-34 staining, contrast-enhanced computed tomography, and contrast-enhanced
endoscopic ultrasound. Median microvessel density (165 microvessels/mm2) was chosen as the cutoff to define low microvessel density and high microvessel
density.
Results
The patients with a low microvessel density showed a significantly higher frequency
of nodal metastases (P = .026), G2–G3 tumors (P = .022), and death domain-associated protein/α-thalassemia/mental retardation syndrome
X-linked loss (P = .011) compared to patients with high microvessel density. The contrast-enhanced
computed tomography tumor density in the arterial phase was significantly higher in
patients with high microvessel density compared to those with low microvessel density
(P = .016). The patients with a low microvessel density showed a significantly higher
frequency of contrast-enhanced endoscopic ultrasound arterial hypoenhancement (P = .042) and late washout (P = .034). Contrast-enhanced computed tomography arterial hypoenhancement (P = .007) and contrast-enhanced endoscopic ultrasound late washout (P = .048) independently predicted a low microvessel density in the patients who underwent
contrast-enhanced computed tomography and contrast-enhanced endoscopic ultrasound,
respectively.
Conclusion
A low microvessel density represents a marker of aggressiveness in the patients with
nonfunctioning pancreatic neuroendocrine tumors. Contrast-enhanced computed tomography
and contrast-enhanced endoscopic ultrasound are reliable and easily available tools
for preoperative assessment of microvessel density.
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Article info
Publication history
Published online: August 08, 2022
Accepted:
June 13,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
