Top

European Radiology

Published in:

01-09-2017 | Gastrointestinal

Poorly-differentiated colorectal neuroendocrine tumour: CT differentiation from well-differentiated neuroendocrine tumour and poorly-differentiated adenocarcinomas

Authors: Ji Hee Kang, Se Hyung Kim, Joon Koo Han

Published in: European Radiology | Issue 9/2017

Abstract

Objective

The differentiation of poorly-differentiated neuroendocrine tumours (PD-NETs), well-differentiated NETs (WD-NETs), and adenocarcinomas (ADCs) is important due to different management options and prognoses. This study is to find the differential CT features of colorectal PD-NETs from WD-NETs and ADCs.

Materials and methods

CT features of 25 colorectal WD-NETs, 36 PD-NETs, and 36 ADCs were retrospectively reviewed. Significant variables were assessed using univariate and multivariate analyses. Receiver operating characteristics analysis determined the optimal cut-off value of tumour and lymph node (LN) size.

Results

Large size, rectum location, ulceroinfiltrative morphology without intact overlying mucosa, heterogeneous attenuation with necrosis, presence of ≥3 enlarged LNs, and metastasis were significant variables to differentiate PD-NETs from WD-NETs (P < 0.05). High attenuation on arterial phase, persistently high enhancement pattern, presence of ≥6 enlarged LNs, large LN size, and wash-in/wash-out enhancement pattern of liver metastasis were significant variables to differentiate PD-NETs from ADCs (P < 0.05).

Conclusions

Compared to WD-NETs, colorectal PD-NETs are usually large, heterogeneous, and ulceroinfiltrative mass without intact overlying mucosa involving enlarged LNs and metastasis. High attenuation on arterial phase, presence of enlarged LNs with larger size and greater number, and wash-in/wash-out enhancement pattern of liver metastasis can be useful CT discriminators of PD-NETs from ADCs.

Key Points

• Compared to WD-NETs, PD-NETs more frequently accompany enlarged LNs and metastases.

• Metastatic LNs from PD-NETs are significantly larger than those from ADCs.

• Hepatic metastases from PD-NETs usually show early enhancement and delayed washout.

Yao JC, Hassan M, Phan A et al (2008) One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072CrossRefPubMed

Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) (2010) WHO classification of tumours of the digestive system. IARC France, Lyon

Rindi G, Kloppel G, Alhman H et al (2006) TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 449:395–401CrossRefPubMedPubMedCentral

Strosberg JR, Coppola D, Klimstra DS et al (2010) The NANETS consensus guidelines for the diagnosis and management of poorly differentiated (high-grade) extrapulmonary neuroendocrine carcinomas. Pancreas 39:799–800CrossRefPubMedPubMedCentral

Hainsworth JD, Spigel DR, Litchy S, Greco FA (2006) Phase II trial of paclitaxel, carboplatin, and etoposide in advanced poorly differentiated neuroendocrine carcinoma: a Minnie Pearl Cancer Research Network Study. J Clin Oncol 24:3548–3554CrossRefPubMed

Shafqat H, Ali S, Salhab M, Olszewski AJ (2015) Survival of patients with neuroendocrine carcinoma of the colon and rectum: a population-based analysis. Dis Colon Rectum 58:294–303CrossRefPubMed

Kim SH, Kim SH, Kim MA, Shin CI, Han JK, Choi BI (2015) CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas. Eur Radiol 25:1946–1957CrossRefPubMed

Kim TH, Kim SH, Lee KB, Han JK (2016) Outcome and CT differentiation of gallbladder neuroendocrine tumours from adenocarcinomas. Eur Radiol. doi:10.1007/s00330-016-4394-3

Ganeshan D, Bhosale P, Yang T, Kundra V (2013) Imaging features of carcinoid tumors of the gastrointestinal tract. Am J Roentgenol 201:773–786CrossRef

10.

Reznek RH (2006) CT/MRI of neuroendocrine tumours. Cancer Imaging 6:S163–S177CrossRefPubMedPubMedCentral

11.

Chi YK, Zhang XP, Li J, Sun YS (2011) To be or not to be: significance of lymph nodes on pretreatment CT in predicting survival of rectal cancer patients. Eur J Radiol 77:473–477CrossRefPubMed

12.

Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83CrossRefPubMed

13.

Díez M, Teulé A, Salazar R (2013) Gastroenteropancreatic neuroendocrine tumors: diagnosis and treatment. Ann Gastroenterol 26:29–36PubMedPubMedCentral

14.

Sahani DV, Bonaffini PA, Fernández-Del Castillo C, Blake MA (2013) Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 266:38–61CrossRefPubMed

15.

Konishi T, Watanabe T, Nagawa H et al (2010) Treatment of colorectal carcinoids: a new paradigm. World J Gastrointest Surg 2:153–156CrossRefPubMedPubMedCentral

16.

Seow-Choen F, Ho J, Jetmore AB (1993) Tiny carcinoids may be malignant. Dis Colon Rectum 36:309–310CrossRef

17.

Dromain C, de Baere T, Baudin E et al (2003) MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques. Am J Roentgenol 180:121–128CrossRef

18.

Ni S-J, Sheng W-Q, Du X (2010) Pathologic research update of colorectal neuroendocrine tumors. World J Gastroenterol 16:1713–1719CrossRefPubMedPubMedCentral

Title: Poorly-differentiated colorectal neuroendocrine tumour: CT differentiation from well-differentiated neuroendocrine tumour and poorly-differentiated adenocarcinomas
Authors: Ji Hee Kang
Se Hyung Kim
Joon Koo Han
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4764-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Poorly-differentiated colorectal neuroendocrine tumour: CT differentiation from well-differentiated neuroendocrine tumour and poorly-differentiated adenocarcinomas

Abstract

Objective

Materials and methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 9/2017

Efficacy of a dynamic collimator for overranging dose reduction in a second- and third-generation dual source CT scanner

A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

Non-specific benign pathological results on transthoracic core-needle biopsy: how to differentiate false-negatives?

Dynamic contrast-enhanced MR imaging pharmacokinetic parameters as predictors of treatment response of brain metastases in patients with lung cancer

Improvement of image quality and dose management in CT fluoroscopy by iterative 3D image reconstruction

Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions