Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy
- 2 March 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Endocrinological Investigation
- Vol. 44 (10), 2227-2234
- https://doi.org/10.1007/s40618-021-01528-1
Abstract
Purpose Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. Methods Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. Results From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. Conclusions Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.Keywords
This publication has 42 references indexed in Scilit:
- Treatment of ampullary neuroendocrine tumor by endoscopic snare papillectomyThe American Journal of Case Reports, 2013
- Endoscopic resection of duodenal bulb neuroendocrine tumor larger than 10 mm in diameterBMC Gastroenterology, 2011
- Periampullary carcinoid tumorEndoscopy, 2007
- TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading systemVirchows Archiv, 2006
- Well-Differentiated Duodenal Tumor/Carcinoma (Excluding Gastrinomas)Neuroendocrinology, 2006
- Duodenal neuroendocrine tumors: Classification, functional syndromes, diagnosis and medical treatmentBest Practice & Research Clinical Gastroenterology, 2005
- Early‐stage carcinoids of the gastrointestinal tractCancer, 2005
- Local Endoscopic Removal of Duodenal Carcinoid TumorsEndoscopy, 2004
- Endoscopic Mucosal Resection in the Management of Gastric Carcinoid TumorsEndoscopy, 2003
- Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas.Gut, 1996