The evolving role of imaging for small bowel neuroendocrine neoplasms: estimated impact of imaging and disease-free survival in a retrospective observational study

Sarasa Kim, Roy Marcus, Michael L. Wells, Shannon P. Sheedy, Stephanie L. Hansel, David H. Bruining, John M. Barlow, Rickey E. Carter, Yong S. Lee, Matthew P. Johnson, Jeff L. Fidler, Ajit H. Goenka, Cynthia H. McCollough, Joel G. Fletcher

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Abstract

Purpose: To determine how small bowel neuroendocrine neoplasms (SBNEN’s) are diagnosed and examine the effect of CT enterography (CTE) on diagnosis and rates of disease-free survival. Methods: Histopathologically-confirmed SBNEN’s diagnosed at our institution between 1996 and 2016 were identified. Clinical presentation, radiology, endoscopy, surgery, and pathology reports were reviewed and compared between consecutive 5-year periods. Results: Of the 178 SBNEN initially diagnosed at our institution, the incidence increased 12-fold from 9 (during 1996–2000) to 114 (during 2011–2016). Comparing the first 5 to the last 5 years, GI bleeding and abdominal pain increased significantly as indications (with both increasing from 0 to > 25%, p ≤ 0.023). Initial diagnosis by radiology increased 2-fold [from 33% (n = 3) to 66% (n = 75); p = 0.263]. Detection of a small bowel mass and the suggestion that SBNEN was present varied significantly between imaging modalities (p < 0.0001; CTE − 95% (52/55) and 91% (50/55) vs. abdominal CT 45% (37/85) and 35% (29/85), respectively). Recurrence rates increased with SBNEN size (p = 0.012; e.g., of SBNEN diagnosed by endoscopy, 18% of SBNEN measuring 0.6 ± 0.3 cm recurred vs. 75% measuring 3.7 ± 1.0 cm). Rates of disease-free survival, and the incidence of local and liver metastases were decreased when tumors were first identified by CTE rather than other CT/MR imaging modalities (p = 0.0034, 0.0475, and 0.0032, respectively). Conclusion: There has been a dramatic increase in SBNENs detected by CTE and endoscopy over the last 20 years. SBNEN’s detected by CTE and small tumors detected at endoscopy have longer disease-free survival after surgical resection.

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • Abdominal neoplasms
  • Computed tomography, X-Ray
  • Endoscopy, Gastrointestinal
  • Intestine, Small

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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