TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system

Abstract

Criteria for the staging and grading of neuroendocrine tumors (NETs) of midgut and hindgut origin were established at the second Consensus Conference in Frascati (Rome) organized by the European Neuroendocrine Tumor Society (ENETS). The proposed tumor-node-metastasis (TNM) classifications are based on the recently published ENETS Guidelines for the Diagnosis and Treatment of gastroenteropancreatic NETs and follow our previous proposal for foregut tumors. The new TNM classifications for NETs of the ileum, appendix, colon, and rectum, and the grading system were designed, discussed, and consensually approved by all conference participants. These proposals need to be validated and are meant to help clinicians in the stratification, treatment and follow-up of patients.

Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga‐DOTATATE (DOTA‐DPhe1,Tyr3‐octreotate) and 18F‐FDG

“…The histologic grading was based on recent consensus statements of the European Neuroendocrine Tumor Society, using mitotic index and Ki67 index in staging of NET along with immunohistochemistry (IHC). 12,13 On the basis of this system well-differentiated tumors with a Ki67 index of 2% and a mitotic index of <2 per HPF (high power field) were classified as low grade. Tumors with a Ki67 index of between 3%-20% and mitotic count of 2-20 per HPF were classified as intermediate grade.…”

High-resolution genomic profiling reveals gain of chromosome 14 as a predictor of poor outcome in ileal carcinoids

“…Diagnostic criteria for ileal carcinoids were according to the World Health Organization (WHO) classification (Capella et al 2000). Grading and staging were according to ENETS recommendations (Rindi et al 2007). Staging of tumours was performed by assessing tumour-nodemetastasis (TNM).…”

“…a According to ENETS proposal (see Ref. Rindi et al (2007) samples. The average number of CNAs per tumour sample was 7.1 (range 1-22).…”

Behavior of small, asymptomatic, nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs)

“…This grading classification uses the mitotic rate and Ki-67 labeling index. 16 General features of prognostic significance include tumor size, vascular invasion, mitotic rate, proliferation index, and nodal and distant metastases. 17 According to the WHO classification of NF-PNETs, the tumor size correlates with the potential for malignancy, and localized tumors measuring >2 cm should preferentially be treated with standard pancreatic resections.…”