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Open Access 01-10-2006 | Original Article

TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system

Authors: G. Rindi, G. Klöppel, H. Alhman, M. Caplin, A. Couvelard, W. W. de Herder, B. Erikssson, A. Falchetti, M. Falconi, P. Komminoth, M. Körner, J. M. Lopes, A-M. McNicol, O. Nilsson, A. Perren, A. Scarpa, J-Y. Scoazec, B. Wiedenmann, and all other Frascati Consensus Conference participants

Published in: Virchows Archiv | Issue 4/2006

Abstract

The need for standards in the management of patients with endocrine tumors of the digestive system prompted the European Neuroendocrine Tumor Society (ENETS) to organize a first Consensus Conference, which was held in Frascati (Rome) and was based on the recently published ENETS guidelines on the diagnosis and treatment of digestive neuroendocrine tumors (NET). Here, we report the tumor–node–metastasis proposal for foregut NETs of the stomach, duodenum, and pancreas that was designed, discussed, and consensually approved at this conference. In addition, we report the proposal for a working formulation for the grading of digestive NETs based on mitotic count and Ki-67 index. This proposal, which needs to be validated, is meant to help clinicians in the stratification, treatment, and follow-up of patients.

Anlauf M, Perren A, Meyer CL, Schmid S, Saremaslani P, Kruse ML, Weihe E, Komminoth P, Heitz PU, Klöppel G (2005) Precursor lesions in patients with multiple endocrine neoplasia type 1-associated duodenal gastrinomas. Gastroenterology 128:1187–1198PubMedCrossRef

Anlauf M, Wieben D, Perren A, Sipos B, Komminoth P, Raffel A, Kruse ML, Fottner C, Knoefel WT, Monig H, Heitz PU, Klöppel G (2005) Persistent hyperinsulinemic hypoglycemia in 15 adults with diffuse nesidioblastosis: diagnostic criteria, incidence, and characterization of beta-cell changes. Am J Surg Pathol 29:524–533PubMedCrossRef

Artale S, Giannetta L, Cerea G, Pedrazzoli P, Schiavetto I, Napolitano M, Veronese S, Bramerio E, Gambacorta M, Vanzulli A, Pisconti S, Pugliese R, Siena S (2005) Treatment of metastatic neuroendocrine carcinomas based on WHO classification. Anticancer Res 25:4463–4469PubMed

Bajetta E, Catena L, Procopio G, Bichisao E, Ferrari L, Della Torre S, De Dosso S, Iacobelli S, Buzzoni R, Mariani L, Rosai J (2005) Is the new WHO classification of neuroendocrine tumours useful for selecting an appropriate treatment? Ann Oncol 16:1374–1380PubMedCrossRef

DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds) (2004) World Health Organization classification of tumours, pathology and genetics of tumours of endocrine organs. IARC, Lyon

Gibril F, Doppman JL, Reynolds JC, Chen CC, Sutliff VE, Yu F, Serrano J, Venzon DJ, Jensen RT (1998) Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management. J Clin Oncol 16:1040–1053PubMed

Hamilton SR, Aaltonen LA (eds) (2000) World Health Organization classification of tumours, pathology and genetics of tumours of the digestive system. IARC, Lyon

Hemminki K, Li X (2001) Familial carcinoid tumors and subsequent cancers: a nation-wide epidemiologic study from Sweden. Int J Cancer 94:444–448PubMedCrossRef

Hemminki K, Li X (2001) Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer 92:2204–2210PubMedCrossRef

10.

Hochwald SN, Zee S, Conlon KC, Colleoni R, Louie O, Brennan MF, Klimstra DS (2002) Prognostic factors in pancreatic endocrine neoplasms: an analysis of 136 cases with a proposal for low-grade and intermediate-grade groups. J Clin Oncol 20:2633–2642PubMedCrossRef

11.

Jensen RT (1999) Natural history of digestive endocrine tumors. In: Mignon M, Colombel JF (eds) Recent advances in the pathophysiology and management of inflammatory bowel diseases and digestive endocrine tumors. John Libbey Eurotext, Montrouge, pp 192–219

12.

Maggard MA, O’Connell JB, Ko CY (2004) Updated population-based review of carcinoid tumors. Ann Surg 240:117–122PubMedCrossRef

13.

Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (2005) Current status of gastrointestinal carcinoids. Gastroenterology 128:1717–1751PubMedCrossRef

14.

Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97:934–959PubMedCrossRef

15.

Öberendorfer S (1907) Karzinoide tumoren des Dünndarms. Frankf Z Pathol 1:426–432

16.

Oberg K, Astrup L, Eriksson B, Falkmer SE, Falkmer UG, Gustafsen J, Haglund C, Knigge U, Vatn MH, Valimaki M (2004) Guidelines for the management of gastroenteropancreatic neuroendocrine tumours (including bronchopulmonary and thymic neoplasms). Part I—general overview. Acta Oncol 43:617–625PubMedCrossRef

17.

Oberg K, Astrup L, Eriksson B, Falkmer SE, Falkmer UG, Gustafsen J, Haglund C, Knigge U, Vatn MH, Valimaki M (2004) Guidelines for the management of gastroenteropancreatic neuroendocrine tumours (including bronchopulmonary and thymic neoplasms). Part II—specific NE tumour types. Acta Oncol 43:626–636PubMedCrossRef

18.

Oberg K, Kvols L, Caplin M, Delle Fave G, de Herder W, Rindi G, Ruszniewski P, Woltering EA, Wiedenmann B (2004) Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 15:966–973PubMedCrossRef

19.

Panzuto F, Di Fonzo M, Iannicelli E, Sciuto R, Maini CL, Capurso G, Milione M, Cattaruzza MS, Falconi M, David V, Ziparo V, Pederzoli P, Bordi C, Delle Fave G (2006) Long-term clinical outcome of somatostatin analogues for treatment of progressive, metastatic, well-differentiated entero-pancreatic endocrine carcinoma. Ann Oncol 17:461–466PubMedCrossRef

20.

Panzuto F, Nasoni S, Falconi M, Corleto VD, Capurso G, Cassetta S, Di Fonzo M, Tornatore V, Milione M, Angeletti S, Cattaruzza MS, Ziparo V, Bordi C, Pederzoli P, Delle Fave G (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12:1083–1092PubMedCrossRef

21.

Pelosi G, Bresaola E, Bogina G, Pasini F, Rodella S, Castelli P, Iacono C, Serio G, Zamboni G (1996) Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables. Hum Pathol 27:1124–1134PubMedCrossRef

22.

Plöckinger U, Rindi G, Arnold R, Eriksson B, Krenning EP, de Herder WW, Goede A, Caplin M, Oberg K, Reubi JC, Nilsson O, Delle Fave G, Ruszniewski P, Ahlman H, Wiedenmann B (2004) Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology 80:394–424PubMedCrossRef

23.

Ramage JK, Davies AH, Ardill J, Bax N, Caplin M, Grossman A, Hawkins R, McNicol AM, Reed N, Sutton R, Thakker R, Aylwin S, Breen D, Britton K, Buchanan K, Corrie P, Gillams A, Lewington V, McCance D, Meeran K, Watkinson A (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 54(Suppl 4):iv1–iv16PubMedCrossRef

24.

Rigaud G, Missiaglia E, Moore PS, Zamboni G, Falconi M, Talamini G, Pesci A, Baron A, Lissandrini D, Rindi G, Grigolato P, Pederzoli P, Scarpa A (2001) High resolution allelotype of nonfunctional pancreatic endocrine tumors: identification of two molecular subgroups with clinical implications. Cancer Res 61:285–292PubMed

25.

Rindi G, Azzoni C, La Rosa S, Klersy C, Paolotti D, Rappel S, Stolte M, Capella C, Bordi C, Solcia E (1999) ECL cell tumor and poorly differentiated endocrine carcinoma of the stomach: prognostic evaluation by pathological analysis. Gastroenterology 116:532–542PubMedCrossRef

26.

Rindi G, Villanacci V, Ubiali A (2000) Biological and molecular aspects of gastroenteropancreatic neuroendocrine tumors. Digestion 45:19–26CrossRef

27.

Ruszniewski P, Ish-Shalom S, Wymenga M, O’Toole D, Arnold R, Tomassetti P, Bax N, Caplin M, Eriksson B, Glaser B, Ducreux M, Lombard-Bohas C, de Herder WW, Delle Fave G, Reed N, Seitz JF, Van Cutsem E, Grossman A, Rougier P, Schmidt W, Wiedenmann B (2004) Rapid and sustained relief from the symptoms of carcinoid syndrome: results from an open 6-month study of the 28-day prolonged-release formulation of lanreotide. Neuroendocrinology 80:244–251PubMedCrossRef

28.

Sandor A, Modlin IM (1998) A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol 93:422–428PubMedCrossRef

29.

Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumours. Wiley-Liss, New York

30.

Solcia E, Bordi C, Creutzfeldt W, Dayal Y, Dayan AD, Fålkmer S, Grimelius L, Havu N (1988) Histopathological classification of nonantral gastric endocrine growths in man. Digestion 41:185–200PubMedCrossRef

31.

Solcia E, Klöppel G, Sobin LH (2000) Histological typing of endocrine tumours. Springer, Berlin Heidelberg New York

32.

Van Eeden S, Quaedvlieg PF, Taal BG, Offerhaus GJ, Lamers CB, Van Velthuysen ML (2002) Classification of low-grade neuroendocrine tumors of midgut and unknown origin. Hum Pathol 33:1126–1132PubMedCrossRef

33.

Wiedenmann B (2004) From ENET to ENETS: a long odyssey in the land of small and rare tumors. Neuroendocrinology 80:1–12CrossRef

Title: TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system
Authors: G. Rindi
G. Klöppel
H. Alhman
M. Caplin
A. Couvelard
W. W. de Herder
B. Erikssson
A. Falchetti
M. Falconi
P. Komminoth
M. Körner
J. M. Lopes
A-M. McNicol
O. Nilsson
A. Perren
A. Scarpa
J-Y. Scoazec
B. Wiedenmann
and all other Frascati Consensus Conference participants
Publication date: 01-10-2006
Publisher: Springer-Verlag
Published in: Virchows Archiv / Issue 4/2006
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-006-0250-1

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TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system

Abstract

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