Tools for diagnosing neuroendocrine tumors

Diagnosing NETs can be a challenge. The appropriate use of biomarker testing may be helpful in making a diagnosis of a NET, even in the absence of a secretory syndrome.1 Imaging and/or endoscopic techniques are useful for localizing primary neoplasms and their metastases, and for planning a definitive biopsy.1,2 A wide range of additional tools also support your diagnostic efforts, and new imaging and biochemical testing techniques continue to be developed and refined by researchers. Click on any of the descriptions below to learn more.

Imaging

Computed tomography (CT): A widely available tool for the localization and staging of solid tumors, including NETs.2 Learn more

Magnetic resonance imaging (MRI): A well-recognized imaging technique, useful in the localization of NETs and their metastases.2-4 Learn more

Octreoscan™: A unique, whole-body imaging technique that identifies primary NETs and metastases that express somatostatin receptors.5 Learn more

Octreoscan is a trademark of Covidien AG or one of its affiliates.

131Iodine metaiodobenzylguanidine (MIBG) scintigraphy: Uses an injected radioisotope to locate and monitor primary and/or metastatic pheochromocytoma and neuroblastoma, as well as certain other NETs.6-8 Learn more

Biomarkers

Chromogranin A (CgA): Up to 90% of patients with NETs have elevated CgA levels.9,10 Learn more

5-Hydroxyindoleacetic acid (5-HIAA): Has diagnostic and prognostic value in NETs associated with carcinoid syndrome.1,5,11 Learn more

Plasma neuronal specific enolase (NSE): A useful circulating marker for poorly differentiated NETs, where NSE sensitivity exceeds 70% and specificity can reach 85%.12

Biochemical Tests

Biochemical tests measuring substances secreted by functional pancreatic NETs can be useful for diagnosis.13
Learn more

Endoscopic Techniques

GI endoscopy: A number of endoscopic techniques may allow visualization of GI lesions,1,14-16 particularly in the stomach, duodenum, and rectum.5 Learn more

Endoscopic ultrasound: A relatively noninvasive technique with low morbidity that helps visualize pancreatic NETs.17 Learn more

Pathology

Accurate pathologic evaluation is important in confirming a NET diagnosis and assessing tumor grade. Learn more

Request a NET Specialist

Continue the conversation about neuroendocrine tumors and diagnosis at your convenience.

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Carcinoid Syndrome

Multidisciplinary Approach

Which NET patients does it affect and what can be done? Patients and HCPs alike can learn more about carcinoid syndrome at
www.carcinoid.com

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Monitoring NETs

Multidisciplinary Approach

Many of the same tools that can be used to diagnose NETs can be helpful in monitoring them.

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1. Mamikunian G, Vinik AI, O'Dorisio TM, Woltering EA, Go VLW. Diagnosing and treating gastroenteropancreatic tumors, including ICD-9 codes. In: Neuroendocrine Tumors: A Comprehensive Guide to Diagnosis and Management. 4th ed. Inglewood, CA: Inter Science Institute; 2009:1-43.
2. Reznek RH. CT/MRI of neuroendocrine tumors. Cancer Imaging. 2006;6:S163-S177.
2. Reznek RH. CT/MRI of neuroendocrine tumors. Cancer Imaging. 2006;6:S163-S177.
3. Dromain C, de Baere T, Lumbroso J, et al. Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging. J Clin Oncol. 2005;23(1):70-78.
4. Gibril F, Jensen RT. Comparative analysis of diagnostic techniques for localization of gastrointestinal neuroendocrine tumors. Yale J Biol Med. 1997;70(2):509-522.
5. Jensen RT, Doherty GM. Carcinoid tumors and the carcinoid syndrome. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:1559-1574.
6. DRAXIMAGE MIBG [package insert]. Kirkland, Quebec, Canada: DRAXIMAGE, a division of DRAXIS Specialty Pharmaceuticals Inc; March 2006.
7. Ezziddin S, Logvinski T, Yong-Hing C, et al. Factors predicting tracer uptake in somatostatin receptor and MIBG scintigraphy of metastatic gastroenteropancreatic neuroendocrine tumors. J Nucl Med. 2006;47(2):223-233.
8. Medline Plus Medical Encyclopedia. MIBG scintiscan. http://www.nlm.nih.gov/medlineplus/ency/article
/003830.htm. Accessed April 29, 2010.
9. Öberg K. Biochemical diagnosis of neuroendocrine GEP tumor. Yale J Biol Med. 1997;70(5-6):501-508.
10. Peracchi M, Conte D, Gebbia C, et al. Plasma chromogranin A in patients with sporadic gastro-entero-pancreatic neuroendocrine tumors or multiple endocrine neoplasia type 1. Eur J Endocrinol. 2003;148(1):39-43.
12. Ferolla P, Faggiano A, Mansueto G, et al. The biological characterization of neuroendocrine tumors: the role of neuroendocrine markers. J Endocrinol Invest. 2008;31(3):277-286.
11. Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol. 2005;89(3):151-160.
11. Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol. 2005;89(3):151-160.
12. Ferolla P, Faggiano A, Mansueto G, et al. The biological characterization of neuroendocrine tumors: the role of neuroendocrine markers. J Endocrinol Invest. 2008;31(3):277-286.
13. Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, eds. The Merck Manual. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:85-86.
13. Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, eds. The Merck Manual. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:85-86.
14. van Tuyl SAC, van Noorden JT, Timmer R, Stolk MFJ, Kuipers EJ, Taal BG. Detection of small-bowel neuroendocrine tumors by video capsule endoscopy. Gastrointest Endosc. 2006;64(1):66-72.
16. Anderson MA, Carpenter S, Thompson NW, et al. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. 2000;95(9):2271-2277.
14. van Tuyl SAC, van Noorden JT, Timmer R, Stolk MFJ, Kuipers EJ, Taal BG. Detection of small-bowel neuroendocrine tumors by video capsule endoscopy. Gastrointest Endosc. 2006;64(1):66-72.
15. Ross A, Mehdizadeh S, Tokar J, et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci. 2008;53(8):2140-2143.
16. Anderson MA, Carpenter S, Thompson NW, et al. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. 2000;95(9):2271-2277.
17. Vinik AI, Silva MP, Woltering EA, Go VLW, Warner R, Caplin M. Biochemical testing for neuroendocrine tumors. Pancreas. 2009;38(8):876-889.