Tumour diameter is not reliable for management of non-secreting pancreatic neuroendocrine tumours

Mills, Logan, Drymousis, Panagiotis, Vashist, Yogesh, Burdelski, Christoph, Prachalias, Andreas, Srinivasan, Parthi, Menon, Krishna, Cotoi, Corina, Khan, Saboor, Cave, Judith, Armstrong, Thomas, Weickert, Martin O, Izbicki, Jakob, Schrader, Joerg, Frilling, Andreja, Ramage, John K and Srirajaskanthan, Raj (2017) Tumour diameter is not reliable for management of non-secreting pancreatic neuroendocrine tumours. Endocrine Connections, 6 (8), 876-885. (doi:10.1530/EC-17-0293).

Abstract

Small non-functioning pancreatic NETs (pNETs) ≤2 cm can pose a management dilemma in terms of surveillance or resection. There is evidence to suggest that a surveillance approach can be considered since there are no significant radiological changes observed in lesions during long-term follow-up. However, other studies have suggested loco-regional spread can be present in ≤2 cm pNETs. The aim of this study was to characterise the prevalence of malignant features and identify any useful predictive variables in a surgically resected cohort of pNETs. 418 patients with pNETs were identified from 5 NET centres. Of these 227 were included for main analysis of tumour characteristics. Mean age of patients was 57 years, 47% were female. The median follow-up was 48.2 months. Malignant features were identified in 38% of ≤2 cm pNETs. ROC analysis showed that the current cut-off of 20 mm had a sensitivity of 84% for malignancy. The rate of malignant features is in keeping with other surgical series and challenges the belief that small pNETs have a low malignant potential. This study does not support a 20 mm size cut-off as being a solitary safe parameter to exclude malignancy in pNETs.

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