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Journal of Endocrinological Investigation

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01-10-2021 | Metastasis | Original Article

Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy

Authors: R. E. Rossi, A. C. Milanetto, V. Andreasi, D. Campana, J. Coppa, G. Nappo, M. Rinzivillo, P. Invernizzi, R. Modica, A. David, S. Partelli, G. Lamberti, V. Mazzaferro, A. Zerbi, F. Panzuto, C. Pasquali, M. Falconi, S. Massironi, ItaNet (Italian Association for Neuroendocrine Tumours) study group

Published in: Journal of Endocrinological Investigation | Issue 10/2021

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.

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Title: Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy
Authors: R. E. Rossi
A. C. Milanetto
V. Andreasi
D. Campana
J. Coppa
G. Nappo
M. Rinzivillo
P. Invernizzi
R. Modica
A. David
S. Partelli
G. Lamberti
V. Mazzaferro
A. Zerbi
F. Panzuto
C. Pasquali
M. Falconi
S. Massironi
ItaNet (Italian Association for Neuroendocrine Tumours) study group
Publication date: 01-10-2021
Publisher: Springer International Publishing
Keywords: Metastasis
Endoscopy
Published in: Journal of Endocrinological Investigation / Issue 10/2021
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-021-01528-1

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