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van Treijen MJC, van Beek DJ, van Leeuwaarde RS, et al. Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base. J Endocr Soc. 2018;2(9):1067-1088doi: 10.1210/js.2018-00087.
van Treijen, M. J. C., van Beek, D. J., van Leeuwaarde, R. S., Vriens, M. R., & Valk, G. D. (2018). Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base. Journal of the Endocrine Society, 2(9), 1067-1088. https://doi.org/10.1210/js.2018-00087
van Treijen, Mark J C, et al. "Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base." Journal of the Endocrine Society vol. 2,9 (2018): 1067-1088. doi: https://doi.org/10.1210/js.2018-00087
van Treijen MJC, van Beek DJ, van Leeuwaarde RS, Vriens MR, Valk GD. Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base. J Endocr Soc. 2018 Jul 31;2(9):1067-1088. doi: 10.1210/js.2018-00087. eCollection 2018 Sep 01. PMID: 30202829; PMCID: PMC6125714.
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J Endocr Soc. 2018 Jul 31;2(9):1067-1088. doi: 10.1210/js.2018-00087. eCollection 2018 Sep 01.

Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base.

Journal of the Endocrine Society

Mark J C van Treijen, Dirk-Jan van Beek, Rachel S van Leeuwaarde, Menno R Vriens, Gerlof D Valk

Affiliations

  1. Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands.
  2. Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands.

PMID: 30202829 PMCID: PMC6125714 DOI: 10.1210/js.2018-00087

Abstract

In multiple endocrine neoplasia type 1 (MEN1), nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) are the most frequently diagnosed NETs and a leading cause of MEN1-related death. The high prevalence and malignant potential of NF-pNETs outline the need for an evidence-based screening program, as early diagnosis and timely intervention could reduce morbidity and mortality. Controversies exist regarding the value of several diagnostic tests. This systematic review aims to evaluate current literature and amplify an up-to-date evidence-based approach to NF-pNET diagnosis in MEN1. Three databases were systematically searched on the diagnostic value of biomarkers and imaging modalities. Twenty-seven studies were included and critically appraised (modified Quality Assessment of Diagnostic Accuracy Studies). Another 12 studies, providing data on age-related penetrance and tumor growth, were included to assess the optimal frequency and timing of screening. Based on current literature, biomarkers should no longer play a role in the diagnostic process for NF-pNETs, as accuracies are too low. Studies evaluating the diagnostic value of imaging modalities are heterogeneous with varying risks of bias. For the detection of NF-pNETs, endoscopic ultrasound (EUS) has the highest sensitivity. A combined strategy of EUS and MRI seems to be the most useful. Gallium 68 octreotate-DOTA positron emission tomography-CT could be added if NF-pNETs are diagnosed to identify metastasis. Reported growth rates were generally low, and two distinct phenotypes were observed. Surveillance programs should focus on and be adapted to the presence of substantial growth in NF-pNETs. The optimal age to start screening must yet be determined, as insufficient evidence for an evidence-based recommendation was available.

Keywords: imaging modalities; multiple endocrine neoplasia type 1; pancreatic neuroendocrine tumors; screening; tumor markers

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