What are the ENETS guidelines on the initial evaluation of neuroendocrine tumors (NETs)?

Updated: Dec 23, 2018
  • Author: Evan S Ong, MD, MS; more...
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Answer

European Neuroendocrine Tumor Society (ENETS) consensus guidelines for high-grade gastroenteropancreatic neuroendocrine tumors, issued in 2016, include the following minimal consensus recommendations on diagnosis [24] :

  • Clinical signs and symptoms should guide the appropriate diagnostic procedures
  • Chromogranin A and neuron-specific enolase (NSE) testing is not mandatory, but may be useful if levels are elevated at diagnosis; other hormone tests are not routinely recommended
  • A minimal diagnostic workup should include site-specific endoscopic assessment with tumor biopsy, and whole-body CT scan (and/or MRI) for tumor staging
  • In patients with metastatic disease, an ultrasound-guided percutaneous biopsy may be performed if feasible
  • Somatostatin receptor scintigraphy is not routinely indicated but may be considered in tumors with proliferative indexes in the low range of G3 (Ki-67 < 55%)
  • Bone scans or brain imaging (CT or MRI) should not be performed in the absence of site-specific symptoms
  • Fluorodeoxyglucose positron emission tomography (FDG-PET) may be considered in patients in whom radical surgery is being pursued or if clarification of equivocal findings on conventional imaging may change the therapeutic approach; FDG-PET may be useful in resectable cases for whole-body assessment

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