Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy
| Autor: | J Coppa, Roberta Elisa Rossi, Stefano Partelli, Valentina Andreasi, Alina David, Davide Campana, Claudio Pasquali, Roberta Modica, Anna Caterina Milanetto, Alessandro Zerbi, Vincenzo Mazzaferro, Maria Rinzivillo, Gennaro Nappo, Massimo Falconi, Sara Massironi, Francesco Panzuto, Giuseppe Lamberti, Pietro Invernizzi |
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| Přispěvatelé: | Rossi, Re, Milanetto, Ac, Andreasi, V, Campana, D, Coppa, J, Nappo, G, Rinzivillo, M, Invernizzi, P, Modica, R, David, A, Partelli, S, Lamberti, G, Mazzaferro, V, Zerbi, A, Panzuto, F, Pasquali, C, Falconi, M, Massironi, S, Rossi, R. E., Milanetto, A. C., Andreasi, V., Campana, D., Coppa, J., Nappo, G., Rinzivillo, M., Invernizzi, P., Modica, R., David, A., Partelli, S., Lamberti, G., Mazzaferro, V., Zerbi, A., Panzuto, F., Pasquali, C., Falconi, M., Massironi, S., Rossi, R, Milanetto, A |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Endoscopic ultrasound Staging Endocrinology Diabetes and Metabolism ultrasound endoscopy surgery 0302 clinical medicine Endocrinology Duodenal Neoplasms Risk Factors Stage (cooking) Duodenal neuroendocrine neoplasm duodenal neuroendocrine neoplasms Digestive System Surgical Procedures Aged 80 and over medicine.diagnostic_test treatment Middle Aged Micrometastases Neuroendocrine Tumors Ultrasound endoscopy Treatment Outcome Lymphatic Metastasis 030220 oncology & carcinogenesis Radiological weapon Micrometastase Treatment strategy Female Radiology Endoscopic treatment micrometastases lymph node metastases Adult medicine.medical_specialty Adolescent Concordance 030209 endocrinology & metabolism Young Adult 03 medical and health sciences Lymph node metastase Preoperative Care medicine Humans Pathological Aged Neoplasm Staging Retrospective Studies business.industry staging Endoscopy Treatment Duodenal neuroendocrine neoplasms Surgery business Lymph node metastases Follow-Up Studies |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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