The multidisciplinary team for gastroenteropancreatic neuroendocrine tumours: the radiologist’s challenge

Granata, Vincenza; Fusco, Roberta; Setola, Sergio Venanzio; Castelguidone, Elisabetta de Lutio di; Camera, Luigi; Tafuto, Salvatore; Avallone, Antonio; Belli, Andrea; Incollingo, Paola; Palaia, Raffaéle; Izzo, Francesco; Petrillo, Antonella

doi:10.2478/raon-2019-0040

Cited by 36 publications

(38 citation statements)

References 80 publications

(144 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the utility of MRI for detection and characterization of focal liver lesions is well established [1,2,[3][4][5][6], its high cost and longer examination time compared with MDCT or ultrasound may limit its widespread use for staging in patients with colorectal cancer (CRC). These limits affect several oncological fields.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging is an important tool in the management of patients with liver metastases by helping enumerate the number and sites of lesions, assessing the resectability, evaluating the response to treatment (systemic or ablative therapies), and detecting drug toxicities [1][2][3][4]. Although multidetector computed tomography (MDCT) is routinely used for primary staging and disease surveillance, Magnetic Resonance imaging (MRI) is a valuable diagnostic technique in oncologic setting, since this tool provides morphological and functional data [5][6][7][8]. Functional data, extracted by diffusion weighted imaging (DWI) and dynamic contrast-enhanced (DCE)-MRI, allow a proper detection and characterization of focal liver lesions [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Although multidetector computed tomography (MDCT) is routinely used for primary staging and disease surveillance, Magnetic Resonance imaging (MRI) is a valuable diagnostic technique in oncologic setting, since this tool provides morphological and functional data [5][6][7][8]. Functional data, extracted by diffusion weighted imaging (DWI) and dynamic contrast-enhanced (DCE)-MRI, allow a proper detection and characterization of focal liver lesions [5][6][7][8]. Oncology is a major field of application of DWI, especially in the detection and characterization of liver metastases [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background MRI is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting. Methods One hundred and eight patients with pathologically proven liver metastases (756 liver metastases) underwent Gd-EOBMRI were enrolled in this study. Three radiologist independently graded the presence of liver lesions on a five-point confidence scale assessed only abbreviated protocol (DWI and sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fat suppressed sequence) and after an interval of more than 2 weeks the conventional study (all acquired sequences). Per-lesion and per-patient detection rate of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion. Results MRI detected 732 liver metastases. All lesions were identified both by conventional study as by abbreviated protocol. In terms of per-lesion detection rate of liver metastasis, all three readers had higher detection rate both with abbreviated protocol and with standard protocol with Gd-EOB (96.8% [732 of 756] vs. 96.5% [730 of 756] for reader 1; 95.8% [725 of 756] vs. 95.2% [720 of 756] for reader 2; 96.5% [730 of 756] vs. 96.5% [730 of 756] for reader 3). Inter-reader agreement of lesions detection rate between the three radiologists was excellent (k range, 0.86–0.98) both for Gd-EOB MRI and for Fast protocol (k range, 0.89–0.99). Conclusion Abbreviated protocol showed the same detection rate than conventional study in detection of liver metastases.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Non-functional pNENs are diagnosed incidentally at an advanced stage with evidence of metastasis. While functional pNENs are small (1-2 cm), well-defined, and hyper-vascular, the non-functional pNENs are large (4 cm), well-defined, encapsulated and heterogeneously enhancing lesions[ 31 ].…”

Section: Clinical Profiles Of Gep-nens Based On the Location Of Tumormentioning

confidence: 99%

Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot

Fernandez¹,

Agarwal²,

Pottakkat³

et al. 2021

WJGS

View full text Add to dashboard Cite

Our understanding about the epidemiological aspects, pathogenesis, molecular diagnosis, and targeted therapies of neuroendocrine neoplasms (NENs) have drastically advanced in the past decade. Gastroenteropancreatic (GEP) NENs originate from the enteroendocrine cells of the embryonic gut which share common endocrine and neural differentiation factors. Most NENs are well-differentiated, and slow growing. Specific neuroendocrine biomarkers that are used in the diagnosis of functional NENs include insulin, glucagon, vasoactive intestinal polypeptide, gastrin, somatostatin, adrenocorticotropin, growth hormone releasing hormone, parathyroid hormone-related peptide, serotonin, histamine, and 5-hydroxy indole acetic acid (5-HIAA). Biomarkers such as pancreatic polypeptide, human chorionic gonadotrophin subunits, neurotensin, ghrelin, and calcitonin are used in the diagnosis of non-functional NENs. 5-HIAA levels correlate with tumour burden, prognosis and development of carcinoid heart disease and mesenteric fibrosis, however several diseases, medications and edible products can falsely elevate the 5-HIAA levels. Organ-specific transcription factors are useful in the differential diagnosis of metastasis from an unknown primary of well-differentiated NENs. Emerging novel biomarkers include circulating tumour cells, circulating tumour DNA, circulating micro-RNAs, and neuroendocrine neoplasms test (NETest) (simultaneous measurement of 51 neuroendocrine-specific marker genes in the peripheral blood). NETest has high sensitivity (85%-98%) and specificity (93%-97%) for the detection of gastrointestinal NENs, and is useful for monitoring treatment response, recurrence, and prognosis. In terms of management, surgery, radiofrequency ablation, symptom control with medications, chemotherapy and molecular targeted therapies are all considered as options. Surgery is the mainstay of treatment, but depends on factors including age of the individual, location, stage, grade, functional status, and the heredity of the tumour (sporadic vs inherited). Medical management is helpful to alleviate the symptoms, manage inoperable lesions, suppress postoperative tumour growth, and manage recurrences. Several molecular-targeted therapies are considered second line to somatostatin analogues. This review is a clinical update on the pathophysiological aspects, diagnostic algorithm, and management of GEP NENs.

show abstract

“…A multidisciplinary team is increasingly used in management of NETS due to their complexity, ideally requiring multiple specialists (surgeons, radiologists, endocrinologists, nuclear medicine specialists) (3,65,66). We believe that nutritionists with expertise in NETs should also be a fundamental component of the multidisciplinary management team as they can provide expert dietary approaches to improve the quality of life as well as nutritional status during the entire treatment pathway.…”

Section: Summing Up Dietary Recommendationsmentioning

confidence: 99%

Role of Diet in the Management of Carcinoid Syndrome: Clinical Recommendations for Nutrition in Patients with Neuroendocrine Tumors

Artale

Barzaghi

Grillo

et al. 2020

Nutrition and Cancer

View full text Add to dashboard Cite

Nutrition and metabolism are altered in patients with gastroenteropancreatic neuroendocrine tumors, which is related to excessive production of gastrointestinal hormones, peptides, and amines that can cause maldigestion, diarrhea, steatorrhea, and altered gastrointestinal motility. Patients with carcinoid syndrome are at risk of malnutrition due to tryptophan depletion, reduced intake of food, and loss of appetite because of diarrhea and/ or flushing. To date, there is limited information on the nutritional issues faced by patients with neuroendocrine tumors, and on what specific recommendations should be made to patients concerning nutrition at various stages of the disease process. Dietary planning should therefore be an integral part of multidisciplinary management for patients with neuroendocrine tumors. Herein, we review current guidance for nutrition in patients with neuroendocrine tumors, focusing on intake of amines and foods to avoid, as well as concurrent medications. We also propose a new and practical food pyramid based on the principles of Mediterranean diet 4.0 that can be easily adapted according to the unmet needs of patients with neuroendocrine tumors at all stages of disease. The overarching goal of the present review is to create greater awareness of nutritional care and considerations that should be given to patients with neuroendocrine tumors.

show abstract

The multidisciplinary team for gastroenteropancreatic neuroendocrine tumours: the radiologist’s challenge

Cited by 36 publications

References 80 publications

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot

Role of Diet in the Management of Carcinoid Syndrome: Clinical Recommendations for Nutrition in Patients with Neuroendocrine Tumors

Contact Info

Product

Resources

About