Therefore, GLP-1R, EUS-FNA or insulin gradient may be helpful (see section 11).ĥ If resected panNET is cured but is G3, which is uncommon, then follow as G1/G2 category.Ħ 18F-FDG PET/CT can identify aggressive NETs (see section 7.D).ĬT, computed tomography EUS-FNA, endoscopic ultrasound with fine needle aspiration F, functioning FDG, fluorodeoxyglucose G1/2/3, grade 1/2/3 (according to the WHO classification system) GI, gastrointestinal GLP-1R, Glucagon-like Peptide 1 receptor MEN1, multiple endocrine neoplasia-type 1 MRI, magnetic resonance imaging NF, non-functioning panNET, pancreatic neuroendocrine tumor PET, positron emission tomography PRRT, peptide receptor radionuclide therapy SSA, somatostatin analogue US, ultrasonography VHL, Von Hippel Lindau Disease.
In MEN1, neither somatostatin receptor imaging nor cross-sectional imaging identify which imaged NET is functional. 1).Īlgorithm of imaging for the management/treatment of panNETġ Diagnosis based on histopathological findings in NF-panNET, and hormone function tests in F-panNET (see section 2).Ģ Sporadic or inherited panNETs frequently managed differently (see section 1).ģ 68Ga PET/CT allows whole body assessment of disease extent and is more sensitive than cross-sectional imaging (see section 7.C).Ĥ Sensitivity of 68Ga-DOTA-SSA PET/CT in insulinomas may be low, due to the low expression/absence of somatostatin receptor subtype 2. Both the grading and the TNM stage have important prognostic roles and also are having an effect on the treatment approaches as well as the imaging approaches which are discussed below ( Fig. The grading categories GI and G2 are well-differentiated NETs, and recently the G3 NETs were subdivided into well-differentiated(G3-NET) and poorly-differentiated(G3, NEC, ) because they have different biologic behaviors/prognoses, different pathogenesis and their treatments differ. The grading is divided into three categories including: G1(Ki6720, MI>20 per 10HPF). The latter relies on the differentiation of the tumors as well as their proliferative activity assessed by the Ki67 index the mitotic rate index(MI). A number of closely related classification systems have been developed including from WHO, European Neuroendocrine Tumor Network(ENETs) and from the International Union for Cancer Control/American Joint Cancer Committee(UICC/AJCC) that including both TNM staging as well as grading of the tumors. This general classification system has allowed a comparison of the biological activity of NETs in different locations which has allowed more general approaches to the development of prognostic factors as well as treatment approaches. Pancreatic neuroendocrine tumors(panNETs)(also call pancreatic endocrine tumors, islet tumors, islet cell tumors) have a distinctive pathogenesis compared to more common adenocarcinomas and are now classified in the general category of Neuroendocrine Tumors(NETs), which also include NETs in other locations, such as carcinoid tumors of the gastrointestinal tract(GI-NETs), as well as those of the respiratory tract.
0 kommentar(er)
