R E Rossi1,2, A C Milanetto3, V Andreasi4, D Campana5, J Coppa6, G Nappo7, M Rinzivillo8, P Invernizzi9, R Modica10, A David3, S Partelli4, G Lamberti5, V Mazzaferro6,11, A Zerbi7, F Panzuto8, C Pasquali3, M Falconi4, S Massironi9. 1. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. robertaelisa.rossi@gmail.com. 2. HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy. robertaelisa.rossi@gmail.com. 3. Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy. 4. Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. 5. Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy. 6. HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy. 7. Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy. 8. Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy. 9. Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy. 10. Division of Endocrinology, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University "Federico II" of Naples, Naples, Italy. 11. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Abstract
PURPOSE: Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. METHODS: Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. RESULTS: From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. CONCLUSIONS: Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.
PURPOSE: Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. METHODS: Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. RESULTS: From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. CONCLUSIONS: Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.
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