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      Histopathological Revision for Gastroenteropancreatic Neuroendocrine Neoplasms in Expert Centers: Does It Make the Difference?

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          Background: The correct histopathological diagnosis of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) is crucial for treatment selection and prognostication. It is also very challenging due to limited experience in nonexpert centers. Revision of pathology is standard of care for most patients who are referred to NEN expert centers. Objectives: To describe the clinical impact of histopathological revision for GEP-NEN patients referred to an expert center. Methods: Retrospective multicenter analysis of all GEP-NENs receiving a histopathological revision in 6 European NEN expert centers (January 2016 to December 2016) to evaluate the impact on patient management. Results: 175 patients were included and 14.7% referred for a second opinion. Histological samples were 69.1% biopsies, 23.4% surgical specimens, and 7.5% endoscopic resections. Histopathological changes due to revision included first assessment of Ki67 in 8.6% of cases, change in grading in 11.4% (3.4% G1 to G2; 5.7% G2 to G1; 0.6% G2 to G3; 1.7% G3 to G2), definition of tumor invasion in 10.8%, additional immunohistochemical staining in 2.3%, diagnosis of mixed adenoneuroendocrine carcinoma in 3.4%, exclusion of NEN in 3.4%, first diagnosis of NEN in 2.3%, and tumor differentiation for G3 in 1.7%. The revision had a clinical impact in 36.0% of patients, leading to a new therapeutic indication in 26.3%. The indication to then perform a new imaging test occurred in 21.1% and recommendation to follow-up with no further treatment in 6.3%. Conclusions: Histopathological revision in expert centers for NENs can change the diagnosis, with a significant clinical impact in about one third of patients.

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          Most cited references 35

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

          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.
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            Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States.

             Arvind Dasari (corresponding) ,  Chan Shen,  Daniel S. Halperin (2017)
            The incidence and prevalence of neuroendocrine tumors (NETs) are thought to be rising, but updated epidemiologic data are lacking.
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              ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas

               R. Garcia-Carbonero (corresponding) ,  H Sorbye,  E Baudin (2016)

                Author and article information

                S. Karger AG
                December 2020
                11 March 2020
                : 111
                : 1-2
                : 170-177
                aDepartment of Gastroenterology, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy
                bDepartment of Internal Medicine, Sector of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
                cDepartment of Gastroenterology and Pancreatology, Beaujon Hospital (APHP) and Paris 7 University, Clichy, France
                dDepartment of Medical Oncology, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
                eDepartment of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
                fDepartment of Gastroenterology, University Hospital Ghent, Ghent, Belgium
                gDepartment of Pathology, Erasmus MC, Rotterdam, The Netherlands
                hDepartment of Pathology, Beaujon/Bichat Hospital (APHP) and Université de Paris, Clichy, France
                iDepartment of Pathology, Academic Medical Center, Amsterdam, The Netherlands
                jDepartment of Pathology, University Hospital Ghent, Ghent, Belgium
                kDepartment of Pathology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
                lDepartment of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
                mDepartment of Endocrinology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
                Author notes
                *Elettra Merola, Department of Gastroenterology, Azienda Provinciale Servizi Sanitari (APSS), Largo Medaglie D’Oro 9, IT–3122 Trento (Italy), elettra.merola@apss.tn.it
                507082 Neuroendocrinology 2021;111:170–177
                © 2020 S. Karger AG, Basel

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                Page count
                Figures: 2, Tables: 3, Pages: 8
                Research Article


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