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Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Surgery 2014 ; 156 (6): 1359-66 Nephropedia Template TP
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A Practical Method to Determine the Site of Unknown Primary in Metastatic Neuroendocrine Tumors #MMPMID25456909
Surgery 2014[Dec]; 156 (6): 1359-66 PMID25456909show ga
Introduction: The primary tumor site is unknown prior to treatment in approximately 20% of small bowel (SBNET) and pancreatic (PNET) neuroendocrine tumors despite extensive workup. It can be difficult to discern a PNET from an SBNET on hematoxylin and eosin (H&E) stains, and thus more focused diagnostic tests are required. Immunohistochemistry (IHC) and gene expression profiling are two methods used to identify the tissue of origin from biopsied metastases. Methods: Tissue microarrays were created from surgical specimens and stained with up to 7 antibodies used in the NET-specific IHC algorithm. Expression of 4 genes for differentiating between PNETs and SBNETs was determined by qPCR and then used in a previously validated gene expression classifier (GEC) algorithm designed to determine the primary site from gastrointestinal (GI) NET metastases. Results: The accuracy of the IHC algorithm in identifying the primary tumor site from a set of 37 metastases was 89.1%, with only 1 incorrect call. Three other samples were indeterminate due to pan-negative staining. The GEC?s accuracy in a set of 136 metastases was 94.1%. It identified the primary tumor site in all cases where IHC failed. Conclusion: Performing IHC, followed by GEC for indeterminate cases, accurately identifies the primary site in SBNET and PNET metastases in virtually all patients.