ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas

Garcia-Carbonero, Rocío; Sørbye, Halfdan; Baudin, Éric; Raymond, Éric; Wiedenmann, Bertram; Niederle, Bruno; Sedláčková, Eva; Toumpanakis, Christos; Anlauf, Martin; Ćwikla, Jarosław; Caplin, Martyn; O’Toole, Dermot; Perren, Aurel

doi:10.1159/000443172

Cited by 535 publications

(587 citation statements)

References 49 publications

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“…What is more important, it is critical for establishing the diagnosis of pancreatic NEC, which in current WHO guidelines is based on assessment of proliferation rate in NEN and independent largely from consideration of morphological picture. As clinical management of NET and NEC is different [6,65], to distinguish between these entities is the most important aspect in diagnostics of neuroendocrine neoplasms [11].…”

Section: Significance Of Ki67 LI In Pancreatic Nenmentioning

confidence: 99%

Tissue heterogeneity contributes to suboptimal precision of WHO 2010 scoring criteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreascriteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreas

Liszka¹

2016

pjp

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Reporting of Ki67 labeling index (LI) is a routine in diagnostics of neuroendocrine neoplasms of the pancreas. The aim of the study was to examine whether heterogeneity of Ki67 LI distribution in primary tumoral tissue influences precision of reporting of Ki67 LI and Ki67-LI-based grade, both established in adherence to WHO 2010 guidelines. Seventy-one samples of neuroendocrine tumours (NET) and 6 samples of neuroendocrine carcinomas (NEC) of the pancreas were taken for manual counting of Ki67 LI in 25 portions of 100 cells (2500 cells in total) in 3 hot spots an in a single area of lower proliferation rate (cold spot) in each case. Both NET and NEC showed Ki67 LI heterogeneity within primary tumour. Almost 20% of NET showed higher grade when 500 cells rather than 2000 cells were counted in hot spot area. Suboptimal choice of hot spot resulted in under-grading of approximately 20% of NET. Cold spots were constantly present in NET. Heterogeneity of Ki67 LI was also present in NEC, but it virtually never resulted in under-grading. Concept and methodology of Ki67 LI counting in neuroendocrine neoplasms of the pancreas requires clarification. Efforts aiming to improve precision of assessment of Ki67 LI are needed.

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Section: Significance Of Ki67 LI In Pancreatic Nenmentioning

confidence: 99%

Tissue heterogeneity contributes to suboptimal precision of WHO 2010 scoring criteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreascriteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreas

Liszka¹

2016

pjp

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“…However, previous studies demonstrated that some pNENs with a high proliferative activity, but well-differentiated degree, are also classified into NEC (15,16). Furthermore, this subtype of pancreatic NEC, named well differentiated NET G3 normally, presented significantly better disease-specific survival than in the poorly differentiated subtype, which suggests that the biological behaviors of the two are different (17)(18)(19). Therefore, a separation of well differentiated NET G3 from poorly differentiated NEC G3 is emerging.…”

Section: Clinical Presentation and Classificationmentioning

confidence: 99%

Pancreatic neuroendocrine tumors

Sun

2017

IRDR

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“…The histopathological assessment is based on the WHO 2017 [69] classification and [69] ENETS 2016 guidelines [4,32] together with the AJCC 8 th edition from 2017 [70]. As in other sections of the gastrointestinal tract, NENs are classified as neuroendocrine well-differentiated neoplasms: NETs G1 with Ki-67 index below 3% and NETs G2 with Ki-67 between 3% and 20%, and NEC, which include NETs G3 and neuroendocrine carcinomas: large-or small-cell NEC, and MiNEN (mixed endocrine non-endocrine neoplasms).…”

Section: Microscopic Assessment On Nensmentioning

confidence: 99%

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Bednarczuk¹,

Bolanowski²,

Zemczak³

et al. 2017

Endokrynologia Polska

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 224Neuroendocrine neoplasms of the small intestine and appendix -management guidelines Bednarczuk Tomasz et al. SZKOLENIE PODYPLOMOWE AbstractThis study presents the revised Polish guidelines regarding the management of patients suffering from neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common location for these neoplasms. Most are well differentiated and slow growing. Their symptoms may be atypical, which can result in delayed or accidental diagnosis. Appendicitis is usually the first manifestation of NEN in this location. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of patients suffering from small intestinal NENs with distant metastases. The main cause of death in patients with carcinoid syndrome is carcinoid heart disease.The most useful laboratory test is the determination of chromogranin A, while concentration of 5-hydroxyindoleacetic acid is helpful in the diagnostics of carcinoid syndrome. For visualisation, ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, double-balloon enteroscopy, and somatostatin receptor scintigraphy may be used. A detailed histological report is crucial for the proper diagnostics and therapy of NENs of the small intestine and appendix. The treatment of choice is surgical management, either radical or palliative. The pharmacological treatment of the hormonally active and non-active small intestinal NENs as well as NENs of the appendix is based on long-acting somatostatin analogues. In patients with generalised NENs of the small intestine in progress during the SSA treatment, with good expression of somatostatin receptors, the first-line treatment should be radioisotope therapy, while targeted therapies, such as everolimus, should be considered afterwards. When the above therapies are exhausted, in certain cases chemotherapy may be considered.(Endokrynol Pol 2017; 68 (2): 223-236)

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ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas

Cited by 535 publications

References 49 publications

Tissue heterogeneity contributes to suboptimal precision of WHO 2010 scoring criteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreascriteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreas

Tissue heterogeneity contributes to suboptimal precision of WHO 2010 scoring criteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreascriteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreas

Pancreatic neuroendocrine tumors

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

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