Nordic guidelines 2014 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Figures & data

Figure 1. Schematic drawing illustrating the classification of NENs.

Table I. The WHO 2010 classification for neuroendocrine neoplasms (NEN) of the digestive system.

Grading of NENs
G1: mitotic count < 2 per 10 high power fields (HPF) and/or ≤ 2% Ki67 index
G2: mitotic count 2–20 per 10 HPF and/or 3–20% Ki67 index
G3: mitotic count > 20 per 10 HPF and/or > 20% Ki67 index

Figure 2. Comparison of the resolution between SRS and PET/CT. A 56-year-old woman with a small intestinal NET G2 since 10 years with known liver metastases and peritoneal carcinomatosis. In picture 2A, SRS depicts only liver metastases, while PET/CT with ⁶⁸Ga-DOTATATE performed one month later, displayed in picture 2B, shows extensive supra- and infra-diaphragmatic lymph node involvement as well as pleural and bone metastases. During the time period between the investigations the patient had radiologically, biochemically and clinically stable disease.

Figure 3. Treatment algorithm for the systemic treatment of pancreatic NETs. *indicates treatment regimens with either streptozotocin + 5-fluourouracil or temozolomide +/2 capecitabine. Debulking treatment, such as surgery, radiofrequency ablation and liver embolisation are not included in the algorithm.

Figure 4. Treatment algorithm for the systemic treatment of small intestinal NETs. Debulking treatment, such as surgery, radiofrequency ablation and liver embolisation are not included in the algorithm.