Echoendoscopic evaluation of the vascular pattern of solid pancreatic lesions as a predictor of neuroendocrine neoplasms: a retrospective study in Mexico

BACKGROUND: Endoscopic ultrasonography (EUS) is essential for evaluating solid pancreatic lesions (SPL). Pancreatic neuroendocrine neoplasms (pNEN) account for 2% of SPL and typically show hypervascularity. This study aimed to assess whether a specific vascular pattern could predict pNEN. METHODS: Patients who underwent EUS for a SPL and were histologically diagnosed with pNEN were included. Tissues were obtained using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and/or surgical resection. Power Doppler was used to assess the vascular patterns. Patients with pNEN were compared to those diagnosed with pancreatic ductal adenocarcinoma during the same period. Group comparisons by size and histological grade were performed using the chi-square test. Logistic regression analysis identified the EUS features associated with pNEN. RESULTS: Among 125 patients (43 pNEN), a peripheral vascular rim (PVR) was associated with pNEN (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7-8.5; p=0.03), with 100% specificity. Hypervascularity (OR, 3.8; 95% CI, 1.1-13.4; p=0.03) and pancreatic atrophy (OR, 0.3; 95% CI, 0.1-0.9; p=0.04) were also associated. CONCLUSIONS: PVR demonstrated 100% specificity and 34.9% sensitivity for pNEN diagnosis, serving as a rule-in sign. PVR visualization may aid in differential diagnosis when EUS-FNB is unavailable or inconclusive.