title: Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors: Toward Defining Evaluation and Management.
abstract: Nonfunctional, non-ampullary duodenal neuroendocrine tumors (dNETs) are rare neoplasms, and specific treatment recommendations are less clear than for other NETs.
  
  
  
  We performed a retrospective review of patients (pts) with a diagnosis of dNET, excluding hormonally functional, ampullary, and high-grade tumors. Clinical data were evaluated to identify factors that might impact clinical staging and predictors of metastases.
  
  
  
  Thirty-six pts were identified. Surgical resection was performed in 28 and endoscopic resection in 8. LNs were included in specimens of 19/28 (68 %) pts who underwent surgical resection (median #LNs 5, range 1-12). Of these 19 pts, 5 (26 %) were found to be LN+. Of LN+ pts, all had tumors ≤2 cm. When compared to LN- pts, LN+ pts were more likely to have muscularis propria (MP) invasion (80 vs. 23 %, p = 0.04). Tumor size, tumor grade, lymphovascular invasion, and multifocality were similar between LN+ and LN- patients. No pt was found to have distant metastases. Heterogeneity in clinical staging modalities and small number of pts evaluated prohibited meaningful analysis of most appropriate preoperative imaging. At a median follow-up of 25 months (range 9-139), no patient developed recurrence or experienced disease-specific death.
  
  
  
  Non-functional, non-ampullary dNETs, particularly those with MP invasion, have a propensity to metastasize to regional LNs. However, these neoplasms appear to have a favorable prognosis. Further evaluation of preoperative imaging is required to better determine most appropriate clinical staging. A suggested workup and management strategy for prospective evaluation is proposed.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Weatherall
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Denbo
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA.
authors.forename: John
authors.initials: J
authors.lastname: Sharpe
authors.affiliation: Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.|West Cancer Center, 7945 Wolf River Blvd, Germantown, TN, 38138, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Martin
authors.affiliation: Memphis Pathology Group, 1211 Union Avenue, Suite 300, Memphis, TN, 38104, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: O'Brien
authors.affiliation: Department of Pathology, University of Tennessee Health Science Center, 930 Madison Ave, 5th Floor, Memphis, TN, 38163, USA.
authors.forename: Rajib
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Pathology Group of the Midsouth, 6019 Walnut Grove Rd, Memphis, TN, 38120, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Groshart
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Behrman
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA. pdickso1@uthsc.edu.
authors.forename: Paxton
authors.initials: P
authors.lastname: Dickson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate