Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus

Megan Casey; Francesca Tozzi; Jaeyun Wang; Keon Min Park; Emily Bergsland; Thomas Hope; Hagen F Kennecke; J. Bart Rose; Michele Babicky; Shayan S Irani; Kevin M El-Hayek; Mohammad Abu Hilal; Horacio J Asbun; Sean Cleary; Peter Smeets; Frederik Berrevoet; Mohamed Adam; Niki Rashidian; Adnan Alseidi; Aman Chauhan; Andrew M Bellizzi; Åsmund A Fretland; Brendan C Visser; Bryson W Katona; Daniel Halperin; Delphine L Chen; Eric Nakakura; Erik Mittra; Flavio G Rocha; Grace E Kim; Heloisa Soares; Anne Hoorens; Jess Maxwell; Jonathan M Loree; Karen Geboes; Linda Lee; Michael H Larsen; Monica Dua; Mustafa Arain; Nadine Mallak; Nancy Joseph; Nitya Raj; Pieter Hindryckx; Sun-Chuan Dai; Thorvardur R Halfdanarson; Bliede Van den Broeck; Pancreatic Neuroendocrine Tumors (PNET) Diagnosis Research Group

doi:10.1007/s00464-025-11667-8

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Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus

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Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus

Megan Casey, Francesca Tozzi, Jaeyun Wang, Keon Min Park, Emily Bergsland, Thomas Hope, Hagen F Kennecke, J. Bart Rose, Michele Babicky, Shayan S Irani, …

Surgical endoscopy : ultrasound and interventional techniques, Vol.39(6), pp.3435-3446

06/2025

DOI: 10.1007/s00464-025-11667-8

PMCID: PMC12116717

PMID: 40316747

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Abstract

Abstract Background Current guidelines lack clarity regarding the appropriate use of preoperative ultrasound-guided (EUS) biopsy and receptor positron emission tomography (SSTR PET) imaging for pancreatic neuroendocrine tumors (PNETs). This study aims to reach expert consensus on the optimal sequencing of SSTR PET and EUS biopsy in the diagnostic workup and management of patients with suspected PNETs. Methods A three-round modified Delphi process was used. A multidisciplinary panel of experts was recruited via snowball sampling. A set of 22 baseline statements pertaining to diagnostic workup, imaging, and biopsy was developed based on literature review and feedback obtained through a focus group. Survey rounds were conducted electronically and anonymously. A panel of international experts was asked to indicate whether they agreed, disagreed, or lacked the appropriate background to answer each statement. Of the 55 experts invited, 38 (69%) accepted to participate. Consensus was achieved with > 80% agreement. Results Response rates were 97%, 100%, and 100% in rounds 1, 2, and 3, respectively. Following rounds 1 and 2, 29 final statements achieved consensus in the following three domains: diagnostic workup (15 statements), imaging (nine statements), and tissue sampling (five statements). Cronbach’s alpha value, a measure of internal consistency, was 0.91 and 0.85 for rounds 1 and 2, respectively. The final set of statements achieved a 95% approval rate in round 3. Conclusion This international Delphi study provides expert consensus-based guidance on the appropriate use of EUS biopsy in the diagnostic workup of PNETs in the era of SSTR PET imaging.

Pancreatic neuroendocrine tumors

Somatostatin receptor positron emission tomography

Tissue sampling

Expert consensus

Diagnostic protocol

Ultrasound-guided biopsy

Details

Title: Subtitle: Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus
Creators: Megan Casey
Francesca Tozzi
Jaeyun Wang
Keon Min Park
Emily Bergsland
Thomas Hope
Hagen F Kennecke
J. Bart Rose - University of Alabama at Birmingham
Michele Babicky
Shayan S Irani
Kevin M El-Hayek
Mohammad Abu Hilal
Horacio J Asbun
Sean Cleary
Peter Smeets
Frederik Berrevoet
Mohamed Adam
Niki Rashidian
Adnan Alseidi
Aman Chauhan
Andrew M Bellizzi
Åsmund A Fretland
Brendan C Visser
Bryson W Katona
Daniel Halperin
Delphine L Chen
Eric Nakakura
Erik Mittra
Flavio G Rocha
Grace E Kim
Heloisa Soares
Anne Hoorens
Jess Maxwell
Jonathan M Loree
Karen Geboes
Linda Lee - Brigham and Women's Hospital
Michael H Larsen
Monica Dua
Mustafa Arain
Nadine Mallak
Nancy Joseph
Nitya Raj
Pieter Hindryckx
Sun-Chuan Dai
Thorvardur R Halfdanarson
Bliede Van den Broeck
Pancreatic Neuroendocrine Tumors (PNET) Diagnosis Research Group
Resource Type: Journal article
Publication Details: Surgical endoscopy : ultrasound and interventional techniques, Vol.39(6), pp.3435-3446
DOI: 10.1007/s00464-025-11667-8
PMID: 40316747
PMCID: PMC12116717
NLM abbreviation: Surg Endosc
ISSN: 0930-2794
eISSN: 1432-2218
Publisher: Springer Science and Business Media LLC
Grant note: Special Research Fund (BOF) of Ghent University: BOF/IOP/2022/049 Fund for Scientific Research -Flanders Belgium Disclosures: 1260123N
This research received no external funding or any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Francesca Tozzi is supported by the Special Research Fund (BOF) of Ghent University (BOF/IOP/2022/049) -Flanders Belgium. Niki Rashidian is supported by a grant for postdoctoral fundamental cancer research (grant file number: 1260123N) of the Fund for Scientific Research -Flanders Belgium Disclosures.
Language: English
Date published: 06/2025
Academic Unit: Pathology
Record Identifier: 9984825339802771

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