Recent advances in the diagnosis and management of pancreatic neuroendocrine tumours

Abstract

The incidence of pancreatic neuroendocrine tumours (PNET) is rising mainly due to the increased use of cross-sectional imaging. Although many PNETs are asymptomatic and non-functioning, the overall 5-year survival is still less than 50%. In this article, we review the advances in diagnosis, classification and staging of PNET that have evolved with the development of new cross-sectional imaging methods and biopsy techniques. With accurate classification, evidence-based, individualised prognostic outcomes and treatments are able to be given which are also discussed.

Keywords: pancreatic cancer; pancreatic disorders; pancreatic endocrine tumour; pancreatic islet cell; pancreatic tumours.

Figure 1

Radiological assessment of pancreatic neuroendocrine tumours. (A) Incidental finding of well-circumscribed lesion on ultrasound. Lesion seen on CT arterial phase (B, C1) with demonstration of vascular washout on portal venous phase (C2). Subsequent endoscopic ultrasound with lesion highlighted dark blue (indicating a hard lesion) on elastography (D) and also allowing fine needle aspiration demonstrating a low mitotic index of <1% (the three black stained cells) with Ki-67 staining (E). Radiolabelled isotope scanning is effective as a diagnostic (octreotide) and treatment (gadolinium) modality (F).