Identification of Unknown Primary Tumors in Patients With Neuroendocrine Liver Metastases

Wang, Sam C.

doi:10.1001/archsurg.2010.10

Cited by 128 publications

(134 citation statements)

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“…Therefore, it was used as standard of reference for the diagnosis. Indeed, a recent study demonstrated both laparotomy and laparoscopic exploration can effectively identify the unknown primary lesion in patients presenting only with liver or node NETs metastases in 86.7% of the cases [13]. Moreover, the authors found multifocal intestinal lesions in 52.4% of the cases.…”

Section: Discussionmentioning

confidence: 99%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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Background & Aims: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumor in patients showing liver NET metastases when first-line investigations are inconclusive.Method: Twenty-four patients with histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.Results: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.Conclusions: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.Abbreviations: DBE: double balloon enteroscopy; GEP-NET: gastro-entero-pancreatic neuroendocrine tumor; GI: gastrointestinal; ENETS: European Neuroendocrine Tumor Society; NET: neuroendocrine tumor; SSRS: somatostatin receptor scintigraphy; WCE: wireless capsule endoscopy.

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Section: Discussionmentioning

confidence: 99%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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“…In particular, CT, somatostatin receptor scintigraphy , enteroclysis, capsule endoscopy, and magnetic resonance imaging enteroclysis have all been found to have some utility for identifying the primary tumor (Picus, Glazer et al 1984;Sugimoto, Lorelius et al 1995;Bader, Semelka et al 2001; van Tuyl, Kuipers et al 2004;Johanssen, Boivin et al 2006). Recently, the sensitivity of diagnostic methods for locating primary tumors in a larger number of patients with well differentiated NET liver metastases was reported by Wang et al (Wang, Parekh et al 2010 In the study by Wang et al, 15 patients with NET liver metastases and unknown primary tumor underwent surgical exploration, 7 of which were laparoscopic. The primary tumor was located in most (87%) patients (Wang, Parekh et al 2010).…”

Section: Methods For Identifying the Primary Sitementioning

confidence: 99%

“…Recently, the sensitivity of diagnostic methods for locating primary tumors in a larger number of patients with well differentiated NET liver metastases was reported by Wang et al (Wang, Parekh et al 2010 In the study by Wang et al, 15 patients with NET liver metastases and unknown primary tumor underwent surgical exploration, 7 of which were laparoscopic. The primary tumor was located in most (87%) patients (Wang, Parekh et al 2010). All identified tumors were in the small intestine.…”

Section: Methods For Identifying the Primary Sitementioning

confidence: 99%

“…Based on these data, for patients with well differentiated (low and intermediate grade) unknown primary tumors and NET liver metastases, a multidisciplinary team assessment for possible surgical exploration and resection of occult primary tumors should be considered. Before surgery, a CT scan, somatostatin receptor scintigraphy, and upper/lower endoscopy should be done (Wang, Parekh et al 2010). EUS may be of value in identifying the location of an insulinoma (Khashab, Yong et al 2011).…”

Section: Methods For Identifying the Primary Sitementioning

confidence: 99%

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The Diagnosis and Management of Neuroendocrine Carcinoma of Unknown Primary

Keiser¹,

Bergsland²,

Nakakura³

2012

Neuroendocrine Tumor

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“…Endoscopic diagnostics of the small intestine is usually undertaken to identify the primary tumour site in the case of metastases of an unknown origin (often significantly larger than the primary tumour), in the case of non-specific abdominal symptoms, or to find the cause of gastrointestinal bleeding [43].…”

Section: Endoscopic Diagnosticsmentioning

confidence: 99%

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Bolanowski

Bednarczuk²,

Bobek-Billewicz³

et al. 2014

Endokrynologia Polska

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We present revised Polish guidelines regarding the management of patients harbouring neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common origin of these neoplasms. Most of them are well differentiated with slow growth. Rarely, they are less differentiated, growing fast with a poor prognosis. Since symptoms can be atypical, the diagnosis is often accidental. Typical symptoms of carcinoid syndrome occur in less than 10% of patients. The most useful laboratory marker is chromogranin A; 5-hydroxyindoleacetic acid is helpful in the monitoring of carcinoid syndrome. Ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, balloon enteroscopy and somatostatin receptors scintigraphy are used in the visualisation. A histological report is crucial for the proper diagnostics and therapy of NENs, and it has been extensively described. The treatment of choice is surgery, either radical or palliative. Somatostatin analogues are crucial in the pharmacological treatment of the hormonally active and non-active small intestine NENs and NENs of the appendix. Radioisotope therapy is possible in patients with a good expression of somatostatin receptors. Chemotherapy is not effective in general. Everolimus therapy can be applied in patients with generalised NENs of the small intestine in progression and where there has been a failure or an inability to use other treatment options. Finally, we make recommendations regarding the monitoring of patients with NENs of the small intestine and appendix. (6) w mniej niż 10% przypadków. W diagnostyce laboratoryjnej najbardziej przydatne jest oznaczenie stężenia chromograniny A, badanie stężenia kwasu 5-hydroksyindolooctowego jest pomocne w monitorowaniu zespołu rakowiaka. W obrazowaniu stosuje się ultrasonografię, tomografię komputerową, rezonans magnetyczny, kolonoskopię, wideoendoskopię kapsułkową, enteroskopię dwubalonową, scyntygrafię receptorów somatostatynowych. Szczegółowe badanie histologiczne jest kluczowym dla właściwego rozpoznania i leczenia chorych z NEN jelita cienkiego i wyrostka robaczkowego. Leczeniem z wyboru jest postępowanie chirurgiczne, radykalne lub paliatywne. W leczeniu farmakologicznym czynnych i nieczynnych hormonalnie NEN jelita cienkiego i wyrostka robaczkowego podstawowe znaczenie mają analogi somatostatyny. Terapia radioizotopowa u chorych z dobrą ekspresją receptorów somatostatynowych stanowi kolejną opcję terapeutyczną. Chemioterapia jest na ogół nieskuteczna. U pacjentów z rozsianym NEN jelita cienkiego i progresją choroby oraz nieskutecznością innych metod terapii można zastosować ewerolimus. Przedstawiono także zalecenia odnośnie monitorowania chorych z NEN jelita cienkiego i wyrostka robaczkowego. (Endokrynol Pol 2013; 64 (6): 444-493)

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Identification of Unknown Primary Tumors in Patients With Neuroendocrine Liver Metastases

Cited by 128 publications

References 16 publications

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

The Diagnosis and Management of Neuroendocrine Carcinoma of Unknown Primary

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

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