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Tumor Staging: Pancreas

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Neuroendocrine Tumors in Real Life

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Abstract

In patients with pancreatic neuroendocrine tumors (pNETs), the assessment of the tumor extent and location and the evaluation of any possible local and/or distant metastases are both required to decide on the proper treatment.

We have reviewed the current evidence on the staging techniques in pNET settings, and we have reported a pertinent case report.

A search was performed on PubMed for the terms: pancreatic neuroendocrine tumors, staging, imaging, endoscopic ultrasound, and nuclear imaging. We searched for all the relevant articles published in PubMed between 1990 and 2016.

Ultrasound endoscopy (EUS) is particularly advantageous in the detection of small, often multifocal pNETs. Of note, as in our case, EUS is extremely useful in the preoperative setting to establish whether a lesion is feasible for surgical resection as it can visualize adjacent vessels and lymphadenopathy. In fact, the invasion of close vessels (e.g., the superior mesenteric artery) represents a contraindication to surgery. Finally, a complete histological assessment of the tumor usually by EUS-guided fine needle aspiration, including the detection of the mitotic Ki-67 index, is needed to tailor the proper treatment to an individual patient. Conventional radiology [i.e., computed tomography (CT) scan and magnetic resonance imaging (MRI)] is used to assess the extent of the tumor and the possible location of the primary lesion. Nuclear imaging [somatostatin receptor scintigraphy (SRS) and, more recently, positron emission tomography (PET) scanning based on 68Ga-radiolabeled somatostatin analogs (Ga-68 PET)] aims at identifying distant metastases – particularly bone metastases which represent a poor prognostic factor and a contraindication to surgery – and somatostatin analog (SSA) receptors prior to medical therapy or peptide radioreceptor therapy (PRRT).

EUS, conventional radiology, and nuclear imaging are all key techniques in the staging of pNETs and should be considered complementary in order to tailor the therapeutic strategy according to a tumor’s and patient’s features.

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Author information

Authors and Affiliations

  1. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Roberta Elisa Rossi & Sara Massironi

  2. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy

    Roberta Elisa Rossi

Authors
  1. Roberta Elisa Rossi
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  2. Sara Massironi
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Correspondence to Sara Massironi .

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Editors and Affiliations

  1. ENETs Center of Excellence for Neuroendocrine Tumours, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Annamaria Colao

  2. ENETs Center of Excellence for Neuroendocrine Tumours, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Antongiulio Faggiano

  3. Endocrine Oncology, Internal Medicine Department, Erasmus University, Rotterdam, Zuid-Holland, The Netherlands

    Wouter de Herder

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Rossi, R.E., Massironi, S. (2018). Tumor Staging: Pancreas. In: Colao, A., Faggiano, A., de Herder, W. (eds) Neuroendocrine Tumors in Real Life. Springer, Cham. https://doi.org/10.1007/978-3-319-59024-0_15

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  • DOI: https://doi.org/10.1007/978-3-319-59024-0_15

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