Short- and long-term outcomes of endoscopic resection of rectal neuroendocrine tumours: analyses according to the WHO 2010 classification

Nakamura, Kazuhiko; Osada, Mikako; Goto, Ayako; Iwasa, Tsutomu; Takahashi, Shunsuke; Takizawa, Nobuyoshi; Akahoshi, Kazuya; Ochiai, Toshiaki; Nakamura, Norimoto; Akiho, Hirotada; Itaba, Soichi; Harada, Naohiko; Iju, Moritomo; Tanaka, Munehiro; Kubo, Hiroaki; Somada, Shinichi; Ihara, Eikichi; Oda, Yoshinao; Ito, Tetsuhide; Takayanagi, Ryoichi

doi:10.3109/00365521.2015.1107752

Cited by 34 publications

(36 citation statements)

References 29 publications

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“…Although this retraction artifact should be accurately histologically distinguished from true lymphatic or vascular invasion, identification of true LVI is not always straightforward on routine hematoxylin and eosin (H&E)-stained slides. Recently, ancillary immunohistochemical staining [D2-40, CD34, CD31, and Elastica van Gieson (EVG)] in addition to H&E histologic examination has been used to evaluate LVI in rectal NETs[31-33]. Through these methods, the high frequency of LVI has been noted in endoscopically resected small rectal NETs[32,33].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, ancillary immunohistochemical staining [D2-40, CD34, CD31, and Elastica van Gieson (EVG)] in addition to H&E histologic examination has been used to evaluate LVI in rectal NETs[31-33]. Through these methods, the high frequency of LVI has been noted in endoscopically resected small rectal NETs[32,33]. However, whether the increased detection rate between H&E and ancillary studies is statistically significant has not been determined.…”

Section: Introductionmentioning

confidence: 99%

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Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors

Kwon

Kang

Soh

et al. 2016

WJG

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AIMTo identify the frequency, clinicopathological risk factors, and prognostic significance of lymphovascular invasion (LVI) in endoscopically resected small rectal neuroendocrine tumors (NETs).METHODSBetween June 2005 and December 2015, 104 cases of endoscopically resected small (≤ 1 cm) rectal NET specimens at Hallym University Sacred Heart Hospital in Korea were retrospectively evaluated. We compared the detected rate of LVI in small rectal NET specimens by two methods: hematoxylin and eosin (H&E) and ancillary immunohistochemical staining (D2-40 and Elastica van Gieson); in addition, LVI detection rate difference between endoscopic procedures were also evaluated. Patient characteristics, prognosis and endoscopic resection results were reviewed by medical charts.RESULTSWe observed LVI rates of 25.0% and 27.9% through H&E and ancillary immunohistochemical staining. The concordance rate between H&E and ancillary studies was 81.7% for detection of LVI, which showed statistically strong agreement between two methods (κ = 0.531, P < 0.001). Two endoscopic methods were studied, including endoscopic submucosal resection with a ligation device and endoscopic submucosal dissection, and no statistically significant difference in the LVI detection rate was detected between the two (26.3% and 26.8%, P = 0.955). LVI was associated with large tumor size (> 5 mm, P = 0.007), tumor grade 2 (P = 0.006). Among those factors, tumor grade 2 was the only independent predictive factor for the presence of LVI (HR = 4.195, 95%CI: 1.321-12.692, P = 0.015). No recurrence was observed over 28.8 mo regardless of the presence of LVI.CONCLUSIONLVI may be present in a high percentage of small rectal NETs, which may not be associated with short-term prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors

Kwon

Kang

Soh

et al. 2016

WJG

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“…However, a number of recent studies have reported a higher than expected rate of venous and/or lymphatic invasion (lymphovascular invasion) in GEP-NET samples obtained via endoscopic procedures [4–6]. In a case series from our own institution, we identified a lymphovascular invasion rate of approximately 30 % for GEP-NETs.…”

Section: Introductionmentioning

confidence: 67%

“…However, recent surveillance data have shown the incidence and prevalence of GEP-NETs to be higher than previously expected, likely due to recent technical advances in endoscopic and imaging examinations [8]. In Japan, the rectum is the most frequent site of GEP-NETs [8], as well as the second most common site in Western countries [4]. …”

Section: Introductionmentioning

confidence: 99%

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The clinicopathological significance of angiogenesis in hindgut neuroendocrine tumors obtained via an endoscopic procedure

et al. 2016

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BackgroundAs the World Health Organization grading system for gastroenteropancreatic-neuroendocrine tumors (GEP-NETs) may not always correlate with tumor progression, it is imperative that other independent predictors of tumor progression be established. To identify such predictors, we conducted a retrospective histopathological study of hindgut NETs, obtained from endoscopic procedures, and used statistical analyses to evaluate predictive factors.MethodsWe first obtained clinicopathological data of cases of hindgut NETs. Tissue sections from tumor samples were prepared and subjected to pathological examination. In particular, we calculated the microvessel density (MVD) and lymphatic microvessel density (LMVD) values, and performed appropriate statistical analyses.ResultsA total of 42 cases of hindgut NETs were selected for the study, 41 from the rectum and 1 from the sigmoid colon. Based on the Ki-67 labeling index, 34 cases were classified as NET G1 tumors and 8 as NET G2 tumors. MVD values ranged from 1.4/mm2 to 73.9/mm2 and LMVD values from 0/mm2 to 22.9/mm2. MVD and LMVD were identified as risk factors for venous and lymphatic invasion of hindgut NETs. Moreover, MVD positively correlated with the maximum diameter of the tumor.ConclusionsTumor progression of NETs may cause angiogenesis and lymphangiogenesis, via an unknown mechanism, as well as lymphovascular invasion. Angiogenesis likely plays an important role in occurrence and progression in the initial phase of hindgut NETs.

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Treatment strategy and post‐treatment management of colorectal neuroendocrine tumor

2023

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Following the increase in colorectal neuroendocrine tumors (NETs), there is a consequent increase in the importance of their appropriate treatment and post‐treatment management. It is widely accepted that colorectal NETs sized ≥20 mm and those with muscularis propria invasion are indicated for radical surgery, and those sized <10 mm without the invasion are indicated for local resection. No consensus has been reached regarding the treatment strategy for those sized 10–19 mm without the invasion. Endoscopic resection has become a primary option for the local resection of colorectal NETs. For rectal NETs sized <10 mm, modified endoscopic mucosal resection, such as endoscopic submucosal resection with ligation device and endoscopic mucosal resection with a cap‐fitted panendoscope, seems favorable because of its ability to achieve a high R0 resection rate, safety, and convenience. Endoscopic submucosal dissection can also be helpful for these lesions; however, this procedure may be more effective for large lesions or those in the colon. Management following local resection of colorectal NETs is based on the pathological evaluation of factors associated with metastasis, including tumor size, invasion depth, tumor cell proliferative activity (NET grading), presence of lymphovascular invasion, and resection margins. There remain unclear issues in managing cases with NET grading ≥2, positive lymphovascular invasion, and positive resection margins following local resection. In particular, there is confusion regarding managing positive lymphovascular invasion because positivity has become remarkably high with the increased use of the immunohistochemical/special staining. Further evidence based on long‐term clinical outcomes is required to address these issues.

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Short- and long-term outcomes of endoscopic resection of rectal neuroendocrine tumours: analyses according to the WHO 2010 classification

Cited by 34 publications

References 29 publications

Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors

Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors

The clinicopathological significance of angiogenesis in hindgut neuroendocrine tumors obtained via an endoscopic procedure

Treatment strategy and post‐treatment management of colorectal neuroendocrine tumor

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