The Value of Preoperative Imaging in Small Bowel Neuroendocrine Tumors

Dahdaleh, Fadi S.; Lorenzen, Allison W.; Rajput, Maheen; Carr, Jennifer C.; Liao, Junlin; Menda, Yusuf; O’Dorisio, Thomas M.; Howe, James R.

doi:10.1245/s10434-012-2836-y

Cited by 35 publications

(35 citation statements)

References 21 publications

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“…The imaging assessment should specify the primary sites (30% multiple) often small in size, the lymph node stage and the presence of hepatic nodules [2,3] . Both CT and MR showed a similar rate of sensitivity in staging disease preoperatively but CT seems to be more effective in detecting anatomical details that matter from a surgical standpoint (i.e., vascular invasion, lymph node involvement) [4,5] . MR, either in T2 sequences or with diffusion-weighted sequences, could better detect hepatic nodules [6] .…”

Section: What Should Be the Minimal Enets Standard Of Care For Preopementioning

confidence: 97%

“…Since the reported correlation between siNETs and other colorectal neoplasms, a colonoscopy may be included in the preoperative workup [8] . A meticulous intraoperative exploration of all abdominal cavity and the palpation of the whole jejunum and ileum are superior to all imaging modalities and should be systematically executed [4,5] .…”

Section: What Should Be the Minimal Enets Standard Of Care For Preopementioning

confidence: 99%

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ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

260

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The small intestine and pancreas are among the most frequent abdominal sites of origin of neuroendocrine tumours. Distinctive features of these forms are represented by the relatively low incidence and the wide heterogeneity in biological behaviour. In this light, it is difficult to standardize indications for surgery and the most appropriate approach. It would be helpful for surgeons managing patients with these tumours to have guidelines for surgical treatment of small intestinal neuroendocrine tumours and pancreatic neuroendocrine tumours. The proposed guidelines represent a consensus of the working group of the European Neuroendocrine Tumor Society (ENETS).

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Section: What Should Be the Minimal Enets Standard Of Care For Preopementioning

confidence: 97%

Section: What Should Be the Minimal Enets Standard Of Care For Preopementioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

260

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show abstract

“…For CT diagnosis of a pancreatic NET (pNET), the lesion detection rates range from 69 to 94% [7][8][9] and 67% sensitivity was reported in one study [10] and 96% in another including patients with von Hippel-Lindau disease [11] . CT sensitivity for NET liver metastases ranges from 75 to 100% [3,[12][13][14][15] and specificity from 83 to 100% [10,12,14,15] .…”

Section: Sensitivity Specificity and Detection Ratementioning

confidence: 99%

“…For lymph node metastases, CT shows 60-70% sensitivity and 87-100% specificity [13,15,17] . For other soft tissue metastases, a 62-67% sensitivity and 98-100% specificity has been reported for CT [3,12,14] .…”

Section: Sensitivity Specificity and Detection Ratementioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

et al. 2017

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Contrast-enhanced computed tomography (CT) of the neck-thorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CT-guided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which ⁶⁸Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. ¹⁸FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.

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“…One recent study evaluating OctreoScans in patients with surgically confirmed small bowel NETs found that either the primary tumor or adjacent nodes had uptake in 74 % of cases, and liver metastases in 66 % (of cases where metastases were present). 4 Functional imaging for NETs has used other agents over the years, including 123 I-Tyr 3 -octreotide and 123 I-MIBG, in addition to the standard of 111 In-octreotide. A more contemporary improvement has come from combining functional imaging with positron emission tomography (PET).…”

mentioning

confidence: 99%

The Supporting Role of 18FDG-PET in Patients with Neuroendocrine Tumors

Howe

2015

Ann Surg Oncol

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There has been a marked, unexplained increasing incidence of neuroendocrine tumors (NETs) over the past few decades. This may be due to a combination of different factors, such as changes in the environment with new exposures to injurious agents or an increased awareness of these neoplasms, but perhaps most of all, improvements in and utilization of body imaging. It has been estimated that as many as 72 million computed tomographic (CT) scans are done per year in the United States, a threefold increase since 1993.1 Abdominal CTs will detect liver metastases, and metastatic disease is found in 30 % of patients with small bowel NETs and 64 % of those with pancreatic NETs.2 Primary pancreatic NETs are commonly seen on CT if they are greater than 1 cm in size and appropriate administration of intravenous contrast is given. Primary small bowel NETs are more subtle because they are frequently small and intramural. They may show up as thickening of the bowel wall or a mass, but more commonly, one may see enlarged, calcified nodes in the mesentery.Although anatomic imaging (CT, MRI) has been very useful, the finding of a mass in the pancreas, mesentery, or liver does not define a tumor as being neuroendocrine in origin. This is where functional imaging for NETs can be useful. For these studies, octreotide is conjugated to a radioisotope, which accumulates in areas with a high density of somatostatin type 2 (SST2) receptors, which are expressed on the cell membranes of the majority of NETs. This has evolved into the exam we know today as OctreoScan, where patients are given an intravenous injection of 111 In-octreotide, and then scintigraphy is performed at 4 and 24 h. One important early study optimistically quoted finding uptake in 96 % of small bowel and 68 % of pancreatic NETs, but never specified whether the uptake seen was in primary tumors or their metastases.3 Nevertheless, this imaging modality has turned out to be useful in NETs from a multitude of primary sites, as long as they express SST2 receptors. Improvements have come over time with the administration of a bowel preparation before imaging, combining with single-photon emission computed tomography (SPECT), and more recently, by coregistration with CT scans. One recent study evaluating OctreoScans in patients with surgically confirmed small bowel NETs found that either the primary tumor or adjacent nodes had uptake in 74 % of cases, and liver metastases in 66 % (of cases where metastases were present).

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The Value of Preoperative Imaging in Small Bowel Neuroendocrine Tumors

Cited by 35 publications

References 21 publications

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Radiological, Nuclear Medicine and Hybrid Imaging

The Supporting Role of 18FDG-PET in Patients with Neuroendocrine Tumors

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