Small bowel neuroendocrine tumors: A critical analysis of diagnostic work‐up and operative approach

Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as 111In pentetreotide (Octreoscan) and 68Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.

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“…The sensitivity in identifying NETs by DBE is 60% to 90%; however, the PPV is only 20% to 30%. [62][63][64]…”

Section: Endoscopymentioning

confidence: 99%

Management of Gastrointestinal Neuroendocrine Tumors

Wang

Zheng-Pywell

Chen

et al. 2019

Clin Med Insights Endocrinol Diabetes

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“…In this study, we developed an objective system for stratifying the extent of MM involvement along the SMA/SMV as a predictor of failure of complete mLND by MIS without conversion. To our knowledge, this is the largest series among studies of MIS for small bowel NETs 24,26‐28 …”

Section: Discussionmentioning

confidence: 97%

A novel stratification of mesenteric mass involvement as a predictor of challenging mesenteric lymph node dissection by minimally invasive approach for ileal neuroendocrine tumors

Kasai

Mahuron

Hirose

et al. 2020

Journal of Surgical Oncology

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Background and Objectives We classified the extent of mesenteric mass (MM) involvement that predicts challenging mesenteric lymph node dissection (mLND) by minimally invasive surgery (MIS) for ileal neuroendocrine tumors (i‐NETs). Methods Patients who underwent surgery for i‐NETs were retrospectively reviewed. MM involvement was classified as region‐0: no MM; region‐1: >2 cm from the origins of the ileocolic artery/vein; region‐2: ≤2 cm from the origins; and region‐3: more proximal superior mesenteric artery/vein. Logistic regression analysis was used to evaluate the predictive value of MM regions for gross positive mesenteric margin (mR2) and/or conversion among the MIS cohort. The open surgery cohort was used as a reference for mR2 rates. Results Of 108 patients, 83 patients (77%) underwent MIS. MMs in region‐2 and region‐3 were independent risk factors for mR2 and/or conversion (odds ratio [95% confidence interval]: 4.25 [1.17‐16.4] and 8.51 × 107 [11.0‐], respectively, against regions‐0 and 1]. mR2 rates of MIS and open surgery cohorts per region did not differ significantly (4% and 7% for regions‐0 and 1; 17% and 25% for region‐2; and 100% and 83% for region‐3). Conclusions The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions.

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“…Diagnostic imaging of insulinoma starts with transabdominal ultrasonography, the sensitivity of which is unfortunately low for small tumours (ultrasound detects about 30% of primary lesions). Endoscopic (EUS) and intraoperative ultrasonography (IOUS) is significantly more sensitive (94-100%) [30,31]. Imaging diagnostics also includes computed tomography (CT) with a contrast medium, magnetic resonance imaging (MRI).…”

Section: Reviewmentioning

confidence: 99%

“…Diagnostykę obrazową insulinoma rozpoczyna się od ultrasonografii przezbrzusznej, której czułość niestety jest niska dla guzów małych (USG wykrywa około 30% zmian pierwotnych). Znacznie większą czułością charakteryzują się ultrasonografia endoskopowa (EUS, endoscopic ultrasonography) (94-100%) lub śródoperacyjna [30,31]. Diagnostyka obrazowa obejmuje również tomografię komputerową (CT, computed tomography) REVIEW z podaniem środka cieniującego, rezonans magnetyczny (MRI, magnetic resonance imaging).…”

Section: Insulinomaunclassified

Hypoglycaemia in endocrine, diabetic, and internal diseases [Hipoglikemia w schorzeniach endokrynologicznych, diabetologicznych i internistycznych]

Rokicka

Marek

Kajdaniuk

et al. 2019

Endokrynologia Polska

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Hypoglycaemia is a decrease in blood glucose concentration below the physiological level. It occurs in healthy people and in people with various diseases with inadequate secretion of insulin by b cells, or deficiency of counterregulatory hormones secreted at the moment of hypoglycaemia. Hypoglycaemia is also associated with diabetes therapy, regardless of whether behavioural therapy, oral hypoglycaemic agents, or insulin are used. Distinguishing the causes of hypoglycaemia is the basis for taking appropriate therapeutic actions that protect patients against subsequent episodes of lowering blood glucose and complications caused by hypoglycaemia.

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Small bowel neuroendocrine tumors: A critical analysis of diagnostic work‐up and operative approach

Cited by 34 publications

References 34 publications

Management of Gastrointestinal Neuroendocrine Tumors

Management of Gastrointestinal Neuroendocrine Tumors

A novel stratification of mesenteric mass involvement as a predictor of challenging mesenteric lymph node dissection by minimally invasive approach for ileal neuroendocrine tumors

Hypoglycaemia in endocrine, diabetic, and internal diseases [Hipoglikemia w schorzeniach endokrynologicznych, diabetologicznych i internistycznych]

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