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Review
. 2023 May;25(5):465-478.
doi: 10.1007/s11912-023-01381-w. Epub 2023 Feb 24.

Integrating Functional Imaging and Molecular Profiling for Optimal Treatment Selection in Neuroendocrine Neoplasms (NEN)

Grace Kong #  1   2 , Emma Boehm #  3   4 , Owen Prall  5 , William K Murray  5 , Richard W Tothill  6   4 , Michael Michael  6   7
Affiliations
Review

Integrating Functional Imaging and Molecular Profiling for Optimal Treatment Selection in Neuroendocrine Neoplasms (NEN)

Grace Kong et al. Curr Oncol Rep. 2023 May.

Abstract

Purpose of review: Gastroenteropancreatic NEN (GEP-NEN) are group of malignancies with significant clinical, anatomical and molecular heterogeneity. High-grade GEP-NEN in particular present unique management challenges.

Recent findings: In the current era, multidisciplinary management with access to a combination of functional imaging and targeted molecular profiling can provide important disease characterisation, guide individualised management and improve patient outcome. Multiple treatment options are now available, and combination and novel therapies are being explored in clinical trials. Precision medicine is highly relevant for a heterogenous disease like NEN. The integration of dual-tracer functional PET/CT imaging, molecular histopathology and genomic data has the potential to be used to gain a more comprehensive understanding of an individual patient's disease biology for precision diagnosis, prognostication and optimal treatment allocation.

Keywords: Functional imaging; Genomics; Molecular profile; Neuroendocrine neoplasms (NEN); Neuroendocrine tumors (NET); PET/CT.

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Conflict of interest statement

All authors declare no conflict of interest. GK has received research funding from Pfizer and Cyclotek, had consulting or advisory role for ITM, and received a Clinical Fellowship Award from the Peter MacCallum Foundation.

Figures

Fig. 1
Fig. 1
A case example of a 54-year-old female, with a previous history of treated localised breast cancer, and previously resected grade 1 (Ki-67 2%) pancreatic NET. She presented with new, multiple hepatic (A) and mesenteric nodal metastases (B). A Ga-68 DOTATATE PET/CT (C) showed metastatic disease in the liver, nodes and bones with high SSTR expression. FDG PET/CT (D) showed some lesions with concordant FDG avidity. The lesion with the highest metabolic activity (mesenteric node, E) was targeted for biopsy and diagnosis. Histopathology (F) showed monotonous cuboidal cells with granular eosinophilic cytoplasm, ovoid nuclei and fine chromatin. By IHC Ki-67 labelling index was 25% (G) and DAXX expression was lost (H). Other IHC (not shown) demonstrated expression of SSTR2 and synaptophysin, retained ATRX and Rb, a p53 wild-type pattern, and no staining for chromogranin or multiple breast markers. Overall, the features were supportive of a G3 NET and not breast carcinoma or NEC. Genomic sequencing confirmed DAXX mutation and MEN1 mutation, typical for NET. The patient proceeded to receive PRRT treatment for metastatic G3 NET
See this image and copyright information in PMC

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