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The Value of Preoperative Imaging in Small Bowel Neuroendocrine Tumors

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neuroendocrine tumors of the small bowel (SBNETs) are a rare but important subgroup of malignancies. Since 30 % of SBNETs present with metastatic disease, often with an occult primary, preoperative imaging is critical for determining who will benefit most from abdominal exploration. We set out to evaluate the usefulness of the two most commonly performed imaging modalities in predicting the extent of disease found at exploration in patients with SBNETs.

Methods

A retrospective chart review was performed on patients with SBNETs resected at 1 institution. Data from preoperative computed tomography (CT) scans were reviewed to determine whether the primary tumor, nodal, or liver metastases were seen, then compared with intraoperative findings. Results of preoperative somatostatin receptor scintigraphy (SRS) were similarly examined.

Results

A total of 62 patients with SBNETs were included. Of these patients, 42 of 62 (68 %) had distant metastases and 48 of 62 (77 %) had nodal metastases at exploration. A total of 56 patients had preoperative CT scans and 47 had SRS. Using CT, a primary tumor was localized to the small bowel in 27 of 56 (48 %) and nodal metastases seen in 33 of 56 (79 %) of cases. SRS found intra-abdominal uptake in 35 of 47 cases (74 %).

Conclusions

CT and SRS are complementary in making the diagnosis of SBNET, with CT giving more precise anatomical detail, while SRS helps to confirm that lesions are NETs and is useful for identifying occult extrahepatic sites of metastatic disease. However, 10–15 % of SBNETs were not identified by either test preoperatively, and therefore surgical exploration still plays an important role in making the diagnosis in these patients.

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Authors and Affiliations

  1. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Fadi S. Dahdaleh MD, Allison Lorenzen MD, Jennifer C. Carr MD, Junlin Liao PhD & James R. Howe MD

  2. Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Maheen Rajput MD & Yusuf Menda MD

  3. Division of Endocrinology and Diabetes, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Thomas M. O’Dorisio MD

Authors
  1. Fadi S. Dahdaleh MD
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  2. Allison Lorenzen MD
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  3. Maheen Rajput MD
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  4. Jennifer C. Carr MD
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  5. Junlin Liao PhD
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  6. Yusuf Menda MD
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  7. Thomas M. O’Dorisio MD
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  8. James R. Howe MD
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Corresponding author

Correspondence to James R. Howe MD.

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Dahdaleh, F.S., Lorenzen, A., Rajput, M. et al. The Value of Preoperative Imaging in Small Bowel Neuroendocrine Tumors. Ann Surg Oncol 20, 1912–1917 (2013). https://doi.org/10.1245/s10434-012-2836-y

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  • DOI: https://doi.org/10.1245/s10434-012-2836-y

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