Appropriate Use of Endoscopic Ultrasound Biopsy in the Diagnosis of Pancreatic Neuroendocrine Tumors In the SSTR PET Era: Results from an International Delphi Consensus Study

 

Megan Casey, BA, Francesca Tozzi, MD, Jaeyun Jane Wang, MD, Keon Min Park, MD, Mohamed Adam, MD, Nikdokht Rashidian, MD, PhD, Adnan Alseidi MD, EdM

 

Introduction: Endoscopic ultrasound-guided (EUS) biopsy, which is frequently used in the diagnostic workup of pancreatic neuroendocrine tumors (PNETs), is invasive and associated with several risks. Current guidelines lack clarity regarding the appropriate use of preoperative EUS biopsy in the diagnostic workup of PNETs in the era of somatostatin receptor (SSTR) PET imaging. This study aims to generate consensus on the topic using the Delphi method.

 

Methods: A three-round modified Delphi process was used. An interdisciplinary panel of experts was recruited. A set of 22 baseline statements in three categories (diagnostic workup, imaging, and biopsy) was developed based on literature review and feedback obtained through a focus group. Voting rounds were conducted via Qualtrics surveys. Statements with >80% agreement were considered to have achieved consensus.

 

Results: A panel of 38 experts (12 surgical oncologists, 9 medical oncologists, 7 gastroenterologists, 6 nuclear medicine/radiologists, and 4 pathologists) agreed to participate in the study, with response rates of 97%, 100% and 100% in rounds 1, 2, and 3 respectively. In the first round, 14/22 statements achieved consensus. The eight statements that did not achieve consensus were modified and nine new statements were added for voting in the second round. In the second round, 15/17 statements achieved consensus. Panelists voted to approve the final set of 29 statements in the third round.    

 

Conclusion: The Delphi method was successfully employed to generate consensus on the proper use of EUS biopsy in the diagnostic workup of PNETs in the era of SSTR PET imaging.