scholarly journals Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

2020 ◽  
Author(s):  
Byung-Soo Park ◽  
Sung Hwan Cho ◽  
Gyung Mo Son ◽  
Hyun Sung Kim ◽  
Su Jin Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumor ◽  
Endoscopic Resection ◽  
Treatment Strategy ◽  
Tumor Size ◽  
Muscularis Propria ◽  
Tumor Grade ◽  
Lymph Node Enlargement ◽  
Significant Difference ◽  
Rectal Neuroendocrine Tumor

Abstract Background: Rectal neuroendocrine tumor (NET) smaller than 10 mm is typically treated with endoscopic resection. Rectal NET larger than 20 mm should be treated with radical surgical resection. However, proper treatment for 10 - 20 mm sized rectal NET is controversial. The purpose of this study was to investigate the appropriate treatment strategy for 10-20 mm sized rectal NET by verifying factors that can predict metastasis.Methods: A total of 23 patients with 10–20 mm sized NET who were treated at Pusan National University Yangsan Hospital from January 2009 to February 2020 were included. The patients were divided into metastasis group and non-metastasis group and their respective data were analyzed.Results: Six patients had metastasis (26.1%) while 17 patients had no metastasis (73.9%). Tumor size in endorectal ultrasound (EUS) was significantly larger in the metastatic group than in the non-metastatic group (p = 0.036), however pathological tumor size did not show significant difference (p = 0.087). The rate of involvement of muscularis propria was 50% in the metastatic group, which was significantly higher than that in the non-metastatic group (p = 0.040). Lymph node enlargement was observed in a single patient (16.7%) in the metastatic group for each of EUS and computed tomography (CT) imaging. Ki-67 index in the metastatic group was higher than in the non-metastatic group. The two groups also showed a significant difference in the proportion of patients with tumor grade 2 (66.7% vs. 5.9%, p = 0.008). In multivariate analysis, tumor grade was the only independent metastasis-predicting factor (p = 0.010). Conclusions: EUS should be performed to evaluate tumor size, and muscularis propria involvement along with CT imaging to check lymph node enlargement before the treatment of 10–20 mm sized rectal NET. If endoscopic resection was performed, tumor grade should be the most important factor to determine whether additional radical resection is necessary.

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor 

2020 ◽  
Author(s):  
Byung-Soo Park ◽  
Sung Hwan Cho ◽  
Gyung Mo Son ◽  
Hyun Sung Kim ◽  
Su Jin Kim ◽  
...  
Keyword(s):  
Tumor Size ◽  
Tumor Grade ◽  
Radical Resection ◽  
Ki 67 ◽  
Appropriate Treatment ◽  
Lymph Node Enlargement ◽  
Significant Difference ◽  
National University ◽  
Rectal Neuroendocrine Tumor ◽  
Predicting Factor

Abstract Background: Rectal neuroendocrine tumors (NET) <10 mm are typically treated with endoscopic resection, while those >20 mm should be treated with radical surgical resection. However, the proper treatment methodology for 10-20-mm sized rectal NETs remains controversial. The purpose of this study was to investigate the appropriate treatment strategy for 10-20-mm sized rectal NETs by verifying factors that can predict metastasis.Methods: A total of 24 patients with 10–20-mm sized NETs who were treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were included. The patients were divided into the metastasis and non-metastasis groups, and their respective data were analyzed.Results: Seven patients had metastasis (29.2%) while 17 patients had no metastasis (70.8%). The tumor size, based on the endorectal ultrasound (EUS) findings, was significantly larger in the metastatic than in the non-metastatic group (14.4 vs. 10.2 mm, p = 0.029); however, the pathological tumor size did not show significant differences (13.3 vs. 11.8 mm, p = 0.065). Lymph node enlargement was observed in a single patient (14.3%) in the metastatic group, based on EUS and computed tomography (CT) imaging findings. The mitotic count (p = 0.017) and Ki-67 index (p = 0.014) were significantly higher in the metastatic group than in the non-metastatic group. The two groups also showed a significant difference in the proportion of patients with tumor grade 2 (71.4% vs. 5.9%, p = 0.003). In multivariate analysis, the tumor grade was the only independent metastasis-predicting factor (odds ratio = 49.25; 95% confidence interval = 2.55–950.83; p = 0.010). Conclusions: Regarding the treatment of 10–20-mm sized rectal NETs, tumor grade 2 should be the most important factor to determine whether additional radical resection is necessary.

scholarly journals Natural Course of an Untreated Metastatic Perirectal Lymph Node After the Endoscopic Resection of a Rectal Neuroendocrine Tumor

2015 ◽  
Vol 13 (2) ◽  
pp. 175 ◽  
Author(s):  
Sang Hyung Kim ◽  
Dong-Hoon Yang ◽  
Jung Su Lee ◽  
Soyoung Park ◽  
Ho-Su Lee ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumor ◽  
Endoscopic Resection ◽  
Natural Course ◽  
Rectal Neuroendocrine Tumor

scholarly journals Tumor grade 2 as the independent predictor for lymph node metastasis in 10–20 mm sized rectal neuroendocrine tumor

2021 ◽  
Vol 17 (1) ◽  
pp. 37-43
Author(s):  
Byung-Soo Park ◽  
Sung Hwan Cho ◽  
Gyung Mo Son ◽  
Hyun Sung Kim ◽  
Su Jin Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Tumor Grade ◽  
Radical Resection ◽  
Independent Factor ◽  
Ki 67 ◽  
Node Metastasis ◽  
Significant Difference ◽  
National University

Purpose: Rectal neuroendocrine tumors (NETs) <10 mm are endoscopically resected, while those ≥20 mm are treated with radical surgical resection. The choice of treatment for 10–20 mm sized rectal NETs remains controversial. This study aimed to verify factors predicting lymph node metastasis (LNM) of 10–20 mm sized rectal NET and utilize them to decide upon the treatment strategy.Methods: Twenty-eight patients with 10–20 mm sized rectal NETs treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were divided into LNM (+) and LNM (–) groups, and their respective data were analyzed.Results: Seven patients (25%) had LNM while 21 patients (75%) did not. Endorectal ultrasound findings showed tumor size was significantly larger in the LNM (+) than in the LNM (–) group (15 mm vs. 10 mm, P=0.018); however, pathologically, there was no significant difference in tumor size (13 mm vs. 11 mm, P=0.109). The mitotic count (P=0.011), Ki-67 index (P=0.008), and proportion of tumor grade 2 patients (5 cases, 71% vs. 1 case, 5%; P=0.001) were significantly higher in the LNM (+) group. In multivariate analysis, tumor grade 2 was the independent factor predicting LNM (odds ratio, 61.32; 95% confidence interval, 3.17–1,188.64; P=0.010).Conclusion: Tumor grade 2 was the independent factor predicting LNM in 10–20 mm sized rectal NETs. Therefore, it could be considered as the meaningful factor in determining whether radical resection is necessary.

scholarly journals A Case of a 5-mm Rectal Neuroendocrine Tumor（Grade 1）with Lymph Node Metastases

2018 ◽  
Vol 79 (4) ◽  
pp. 854-857
Author(s):  
Daiki KAKIUCHI ◽  
Masahiro HADA ◽  
Masahiro OSHIMA ◽  
Yosuke KATO ◽  
Masanori KOTAKE ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumor ◽  
Lymph Node Metastases ◽  
Tumor Grade ◽  
Node Metastases ◽  
Rectal Neuroendocrine Tumor

scholarly journals Grade G2 Rectal Neuroendocrine Tumor Is Much More Invasive Compared With G1 Tumor

2021 ◽  
Vol 11 ◽  
Author(s):  
Yi-Wei Li ◽  
Yi-Ping He ◽  
Fang-Qi Liu ◽  
Jun-Jie Peng ◽  
San-Jun Cai ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neuroendocrine Tumor ◽  
Tumor Size ◽  
Neural Invasion ◽  
Node Metastasis ◽  
Median Tumor Size ◽  
Clinicopathologic Feature ◽  
Rectal Neuroendocrine Tumor ◽  
Frequent Presence

BackgroundTo compare clinicopathologic feature of rectal neuroendocrine tumor (NET) grade G1 with G2 NET.MethodsSix hundred-one cases of rectal G1 and G2 NETs diagnosed in our center were analyzed.ResultsOf 601 cases of rectal NET, 515 cases were with grade G1 and 86 cases were with grade G2. Median tumor size was 0.7 cm. Compared with G1 NET, G2 tumors were with significantly larger tumor size (0.8 vs 2.2 cm, p &lt; 0.001), less percentages of patients with tumors confined to submucosa (92.6 vs 42.8%, p &lt; 0.001), more frequent presence of microvascular invasion (MVI) (3.6 vs 16.9%, p &lt; 0.001) or peri-neural invasion (PNI) (2.0 vs 24.1%, p &lt; 0.001). Incidence of lymph node and distant metastasis was 5.2 and 2.1% in G1 NET compared with 44.2 and 31.4% in G2 tumor, respectively (p &lt; 0.001). For tumors sized 1–2 cm and confined to submucosa, incidence of lymph node metastasis was 6.1% for G1 NET compared with 21.1% for G2 NET. Status of MVI/PNI was predictive of lymph node metastasis for G2 tumor rather than G1 NET in this subgroup.ConclusionsRectal G2 NET was much more invasive with significantly elevated prevalence of lymph node metastasis compared with G1 tumor.

scholarly journals Gastroenteropancreatic neuroendocrine tumor of the accessory papilla of the duodenum: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kosei Takagi ◽  
Yuzo Umeda ◽  
Ryuichi Yoshida ◽  
Kazuhiro Yoshida ◽  
Kazuya Yasui ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumor ◽  
Lymph Node Metastases ◽  
Treatment Strategy ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Ki 67 ◽  
Invasive Approach ◽  
Robotic Pancreatoduodenectomy ◽  
Estimated Blood Loss ◽  
Node Metastases

Abstract Background Contrary to the increasing incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), GEP-NETs of the accessory papilla of the duodenum are extremely rare. Furthermore, there have been no recommendations regarding the treatment strategy for GEP-NETs of the accessory papilla of the duodenum. We present a case of GEP-NET of the accessory papilla of the duodenum successfully treated with robotic pancreatoduodenectomy. Case presentation A case of a 70-year-old complaining of no symptoms was diagnosed with GEP-NET of the accessory papilla of the duodenum. A 8-mm tumor was located at the submucosal layer with a biopsy demonstrating a neuroendocrine tumor grade 1. The patient underwent robotic pancreatoduodenectomy as curative resection for the tumor. The total operative time was 406 min with an estimated blood loss of 150 mL. The histological examination revealed a well-differentiated neuroendocrine tumor with low Ki-67 index (< 1%). In the posterior areas of the pancreas, the lymph node metastases were detected. The patient was followed up for 6 months with no recurrence postoperatively. Conclusions Considering the potential risks of the lymph node metastases, the standard treatment strategy for GEP-NETs of the accessory papilla of the duodenum should be radical resection with pancreatoduodenectomy. Minimally invasive approach can be the alternative to the conventional open surgery.

Rectal neuroendocrine tumor with extracapsular lymph node metastasis: a case report

2021 ◽  
Author(s):  
Akira Sakamoto ◽  
Hiroaki Nozawa ◽  
Hirofumi Sonoda ◽  
Munetoshi Hinata ◽  
Hiroaki Ishii ◽  
...  
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neuroendocrine Tumor ◽  
Node Metastasis ◽  
Rectal Neuroendocrine Tumor

scholarly journals Can conventional DWI accurately assess the size of endometrial cancer?

2019 ◽  
Vol 45 (4) ◽  
pp. 1132-1140 ◽  
Author(s):  
Yanfang Song ◽  
Hua Shang ◽  
Yumei Ma ◽  
Xiaodong Li ◽  
Jingwen Jiang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Tumor Size ◽  
Central Zone ◽  
Tumor Grade ◽  
Maximum Diameter ◽  
Small Lesion ◽  
Surgical Specimen ◽  
Weighted Image ◽  
Significant Difference ◽  
Adc Values

Abstract Purpose To compare T2-weighted image (T2WI) and conventional Diffusion-weighted image (cDWI) of magnetic resonance imaging (MRI) for sensitivity of qualitative diagnosis and accuracy of tumor size (TS) measurement in endometrial cancer (EC). Meanwhile, the effect of the lesion size itself and tumor grade on the ability of T2WI and cDWI of TS assessment was explored. Ultimately, the reason of deviation on size evaluation was studied. Materials and methods 34 patients with EC were enrolled. They were all treated with radical hysterectomy and performed MR examinations before operation. Firstly, the sensitivity of T2WI alone and T2WI–DWI in qualitative diagnosis of EC were compared according to pathology. Secondly, TS on T2WI and cDWI described with longitudinal (LD) and horizontal diameter (HD) were compared to macroscopic surgical specimen (MSS) quantitatively in the entire lesions and the subgroup lesions which grouped by postoperative tumor size itself and tumor grade. Thirdly, the discrepancy of mean ADC values (ADC mean) and range ADC values (ADC range) between different zones of EC were explored. Results For qualitative diagnosis, the sensitivity of T2WI–DWI (97%) was higher than T2WI alone (85%) (p = 0.046).For TS estimation, no significant difference (PLD = 0.579; PHD = 0.261) was observed between T2WI (LDT2WI = 3.90 cm; HDT2WI = 2.88 cm) and MSS (LD = 4.00 cm; HD = 3.06 cm), whereas TS of cDWI (LDDWI = 3.01 cm; HDDWI = 2.54 cm) were smaller than MSS (PLD = 0.002; PHD = 0.002) in all lesions. In subgroup of tumor with G1 (grade 1) and small lesion (defined as maximum diameter < 3 cm), both T2WI and cDWI were not significantly different from MSS; In subgroup of tumor with G2 + 3 (grade 2 and grade 3) and big lesion (maximum diameter ≥ 3 cm), T2WI matched well with MSS still, but DWI lost accuracy significantly. The result of ADC values between different zones of tumor showed ADC mean of EC rose from central zone to peripheral zone of tumor gradually and ADC range widened gradually. Conclusion cDWI can detect EC very sensitively. The TS on cDWI was smaller than the fact for the ECs with G2/3 and big size. The TS of T2WI was in accordance with the actual size for all ECs. The heterogeneity may be responsible for the inaccuracy of cDWI.

Correlation of quantitative total HER2 expression and HER2 homodimers with histopathologic characteristics of breast cancers in the FinHer study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 11061-11061
Author(s):  
W. Huang ◽  
J. Weidler ◽  
Y. Lie ◽  
J. Whitcomb ◽  
M. Leinonen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Dynamic Range ◽  
Tumor Grade ◽  
Her2 Status ◽  
Breast Cancers ◽  
Her2 Expression ◽  
Node Metastasis ◽  
Formalin Fixed Paraffin Embedded

11061 Background: We recently reported that the HERmark assay (Monogram Biosciences) accurately measures continua of total HER2 expression (H2T) and HER2 homodimers (H2D) over a wide (∼3 logs) dynamic range, and that a higher concordance was observed between H2T and HER2 status with more stringent central tests as compared with IHC tests performed locally (Joensuu et al, 2008 SABCS,abstract 2071). H2D/H2T ratio was reported as a marker of activated HER2 and a prognosticator of disease progression in HER2+ patients not treated with trastuzumab in the adjuvant setting (Bates et al, 2008 SABCS,abstract 1074). In this follow-up analysis, H2T, H2D, and H2D/H2T ratio were correlated with histopathologic characteristics of breast cancers in the FinHer study. Methods: The HERmark assay was used to measure H2T and H2D in 899 formalin-fixed, paraffin-embedded FinHer specimens. The results were correlated with histopathologic characteristics of breast cancers in the FinHer study (Joensuu et al, N Engl J Med2006;354), including estrogen receptor/progesterone receptor (ER/PR), tumor grade, tumor size, lymph node metastasis, and stage. Results: Higher H2T and H2D levels correlated with ER/PR negativity and high tumor grade (P<0.0001). 42% (102/244) of ER- and 37% (137/374) of PR- cases were HERmark Positive; while 17% (110/655) of ER+ and 14% (75/524) of PR+ cases were HERmark Positive. 10% (13/136) of grade 1, 18% (65/353) of grade 2, and 35% (131/375) of grade 3 tumors were HERmark Positive. No significant association was found between H2T or H2D and tumor size, lymph node metastasis or stage. ER/PR negative and poorly differentiated cancers had higher H2D/H2T ratios (P=0.013), and H2D/H2T ratios >0.6 were associated with smaller primary tumor diameters at the time of cancer detection (P=0.009). Conclusions: The quantitative H2T measurement confirms the known correlations between HER2 expression and histopathologic characteristics of breast cancer. The novel H2D measurement and H2D/H2T ratio may provide further insights into HER2 activation and better diagnostic tests for targeted HER2 therapy. [Table: see text]

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