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Moderne molekulare und bildgebende Diagnostik bei neuroendokrinen Neoplasien des Pankreas

Modern molecular and imaging diagnostics in pancreatic neuroendocrine neoplasms

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Zusammenfassung

Hintergrund, Ziel der Arbeit

Neue molekulardiagnostische und bildgebende Verfahren bieten sich an für die Einschätzung der Ausdehnung, des Rezidivrisikos, der Prognose und des Therapieansprechens der pankreatischen neuroendokrinen Neoplasien (pNENs) und stellen damit eine entscheidende Hilfestellung für die Indikation chirurgischer Maßnahmen dar, vor allem in fortgeschrittenen Stadien.

Methoden

Es erfolgt die narrative Bewertung der Optionen und der Evidenz für die moderne molekulare und bildgebende Diagnostik bei pNENs auf der Basis der aktuellen Literatur.

Ergebnisse

Während zirkulierende DNA, zirkulierende Tumorzellen und MicroRNAs sich bislang im klinischen Alltag nicht durchsetzen konnten, legt die aktuelle Literatur eine vielversprechende Rolle für den sog. NETest nahe. Aktuelle Studien belegen seine mögliche Bedeutung für die Chirurgie der pNENs. Neben der Positronenemissionstomografie (PET) mit 68Gallium markierten Somatostatinanaloga (68Ga-DOTA-SSA)- und der [18]FDG(Fluorodesoxyglucose)-Positronenemissionstomographie, die der Goldstandard für die Bildgebung der NENs bleiben, stellen Radiomics eine spannende Alternative zur Biopsie dar und werden möglicherweise in der Zukunft eine zunehmend wichtige Rolle spielen.

Diskussion

Zu dem seit den 1970er-Jahren klinisch noch weit verbreiteten Chromogranin A gibt es inzwischen interessante Alternativen, um Ausdehnung, Rezidivrisiko, Prognose und Therapieansprechen der pNENs abzubilden. Im Sinne der personalisierten Medizin sollten die moderne molekulare und die radiologische Diagnostik helfen, chirurgische Therapien und das Follow-up in der Zukunft anzupassen.

Abstract

Background and objective

New molecular diagnostic and radiologic imaging techniques can be used to assess the extent, risk of recurrence, prognosis and response to treatment of pancreatic neuroendocrine neoplasms (pNENs). They therefore represent a decisive help in setting the indications for surgical treatment, especially in advanced stages.

Methods

This article presents a narrative assessment of the options and evidence for modern molecular and radiologic imaging diagnostics of pNENs based on the current literature.

Results

While circulating DNA, circulating tumor cells and microRNAs have not yet become established in everyday clinical practice, the current literature suggests a promising role for the so-called NETest. Recent studies demonstrated its possible importance for the surgical management of pNENs. Besides [68Ga]Ga-DOTA-SSA-PET and [18]FDG-PET, which remain the gold standards for imaging NENs, radiomics represent an exciting alternative to biopsies and will possibly play an increasingly important role in the future.

Discussion

There are new promising alternatives to chromogranin A, which has been clinically widespread since the 1970s despite several drawbacks, to map the extent, risk of recurrence, prognosis and response to treatment of pancreatic pNENs. In terms of personalized medicine, modern molecular and radiological diagnostics should play an increasing role for indicating and planning surgical treatment and for follow-up in the future.

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  1. Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpenerstr. 62, 50937, Köln, Deutschland

    Costanza Chiapponi &  Christiane J Bruns

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Chiapponi, C., Bruns, C.J. Moderne molekulare und bildgebende Diagnostik bei neuroendokrinen Neoplasien des Pankreas. Chirurgie 93, 731–738 (2022). https://doi.org/10.1007/s00104-022-01645-4

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