Insulinoma staging: Difference between revisions

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Latest revision as of 15:07, 5 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.

Staging

American Joint Cancer Committee (AJCC) 7th edition 2010 classification

The staging of malignant insulinoma being a pancreatic neuroendocrine tumor may be classified into several sub types based on American Joint Cancer Committee (AJCC) 7th edition 2010: ^[1]^[2]

Stage	T	N	M
IA	T1	N0	M0
IB	T2	N0	M0
IIA	T3	N0	M0
IIB	T1-3	N1	M0
III	T4	Any N	M0
IV	Any T	Any N	M1

AJCC 2010
T	T1	<2 cm in greatest dimension
	T2	>2 cm in greatest dimension
	T3	Beyond the pancreas but without involvement of the superior mesenteric artery
	T4	Involvement of the celiac axis or superior mesenteric artery (unresectable tumor)
N	N0	No regional lymph node metastasis
N	N1	Regional lymph node metastasis
M	M0	No distant metastasis
M	M1	Distant metastasis

European Neuroendocrine Tumor Society (ENETS) classification:

Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS) as: ^[1]^[2]

Stage	T	N	M
I	T1	N0	M0
IIA	T2	N0	M0
IIB	T3	N0	M0
IIIA	T4	N0	M0
III B	Any T	N1	M0
IV	Any T	Any N	M1

ENETS
T	T1	Tumor limited to pancreas, <2 cm
	T2	Tumor limited to pancreas, 2-4 cm
	T3	>4cm, or invading the duodenum or common bile duct
	T4	Tumor invades adjacent structures
N	N0	No regional lymph node metastasis
N	N1	Regional lymph node metastasis
M	M0	No distant metastasis
M	M1	Distant metastasis

WHO 2010 classification system

WHO classification system combined differentiation and grading characteristics to classify the belligerence of a pancreatic neuroendocrine tumor.
The aggressiveness of tumor was expressed in form of mitotic count and staining of a nuclear antigen called Ki-67: ^[3]^[4]

Grade of tumor	Mitotic Count(Mitoses per 10 high powerfields)	Expression of Ki 67
Grade 1	<2	≤3%
Grade 2	2-10	3-20%
Grade 3	>20	>20%

Grade 1 and 2 tumors were classified as neuroendocrine neoplasm (NET) and grade 3 were classified as neuroendocrine carcinoma (NEC).

In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification:^[1]

Stage	T	N	M
IA	T1	N0	M0
IB	T2	N0	M0
IIA	T3	N0	M0
IIB	T1-3	N1	M0
III	T4	Any N	M0
IV	Any T	Any N	M1

mENETS
T	T1	Tumor limited to pancreas, <2 cm
	T2	Tumor limited to pancreas, 2-4 cm
	T3	>4cm, or invading the duodenum or common bile duct
	T4	Tumor invades adjacent structures
N	N0	No regional lymph node metastasis
N	N1	Regional lymph node metastasis
M	M0	No distant metastasis
M	M1	Distant metastasis

References

↑ ^1.0 ^1.1 ^1.2 Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C; et al. (2017). "Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems". J Clin Oncol. 35 (3): 274–280. doi:10.1200/JCO.2016.67.8193. PMID 27646952.
↑ ^2.0 ^2.1 Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW; et al. (2015). "TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution". Medicine (Baltimore). 94 (12): e660. doi:10.1097/MD.0000000000000660. PMC 4554009. PMID 25816036.
↑ Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.
↑ Sun J (2017). "Pancreatic neuroendocrine tumors". Intractable Rare Dis Res. 6 (1): 21–28. doi:10.5582/irdr.2017.01007. PMC 5359348. PMID 28357177.

[pmid27646952-1] 1.0 ^1.1 ^1.2 Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C; et al. (2017). "Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems". J Clin Oncol. 35 (3): 274–280. doi:10.1200/JCO.2016.67.8193. PMID 27646952.

[pmid25816036-2] 2.0 ^2.1 Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW; et al. (2015). "TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution". Medicine (Baltimore). 94 (12): e660. doi:10.1097/MD.0000000000000660. PMC 4554009. PMID 25816036.

[3] Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.

[pmid28357177-4] Sun J (2017). "Pancreatic neuroendocrine tumors". Intractable Rare Dis Res. 6 (1): 21–28. doi:10.5582/irdr.2017.01007. PMC 5359348. PMID 28357177.

[1]

[2]

[3]

[4]

@@ Line 3: / Line 3: @@
 {{CMG}}; {{AE}}{{ADS}}
 ==Overview==
-The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. <ref name="pmid27646952" /><ref name="pmid25816036" /> Being a [[pancreatic neuroendocrine tumor]], it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.
+The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. Being a [[pancreatic neuroendocrine tumor]], it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.
 ==Staging==
-=== [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010 calssification ===
+=== [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010 classification ===
-The staging of [[malignant]] insulinoma being a [[pancreatic neuroendocrine tumor]] may be classified into several subtypes based on [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010: <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref><ref name="pmid25816036">{{cite journal| author=Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW et al.| title=TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution. | journal=Medicine (Baltimore) | year= 2015 | volume= 94 | issue= 12 | pages= e660 | pmid=25816036 | doi=10.1097/MD.0000000000000660 | pmc=4554009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25816036  }} </ref>
+The staging of [[malignant]] insulinoma being a [[pancreatic neuroendocrine tumor]] may be classified into several sub types based on [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010: <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref><ref name="pmid25816036">{{cite journal| author=Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW et al.| title=TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution. | journal=Medicine (Baltimore) | year= 2015 | volume= 94 | issue= 12 | pages= e660 | pmid=25816036 | doi=10.1097/MD.0000000000000660 | pmc=4554009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25816036  }} </ref>
 {| class="wikitable" align="right"
 | style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
@@ Line 150: / Line 150: @@
 *The aggressiveness of tumor was expressed in form of [[mitotic]] count and staining of a nuclear antigen called [[Ki-67]]: <ref>{{cite book | last = Bosman | first = F. T. | title = WHO classification of tumours of the digestive system | publisher = International Agency for Research on Cancer | location = Lyon | year = 2010 | isbn = 978-9283224327 }}</ref><ref name="pmid28357177">{{cite journal |vauthors=Sun J |title=Pancreatic neuroendocrine tumors |journal=Intractable Rare Dis Res |volume=6 |issue=1 |pages=21–28 |year=2017 |pmid=28357177 |pmc=5359348 |doi=10.5582/irdr.2017.01007 |url=}}</ref>
 {| class="wikitable" style="text-align:center"
-|'''Grade of tumor'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Grade of tumor'''
-|'''Mitotic Count'''(Mitoses per 10 high powerfields)
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Mitotic Count'''(Mitoses per 10 high powerfields)
-|'''Expression of Ki 67'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Expression of Ki 67'''
 |-
-|Grade 1
+| style="background:#DCDCDC;" align="center" + |Grade 1
-|<2
+| style="background:#F5F5F5;" + |<2
-|≤3%
+| style="background:#F5F5F5;" + |≤3%
 |-
-|Grade 2
+| style="background:#DCDCDC;" align="center" + |Grade 2
-|2-10
+| style="background:#F5F5F5;" + |2-10
-|3-20%
+| style="background:#F5F5F5;" + |3-20%
 |-
-|Grade 3
+| style="background:#DCDCDC;" align="center" + |Grade 3
-|>20
+| style="background:#F5F5F5;" + |>20
-|>20%
+| style="background:#F5F5F5;" + |>20%
 |-
 |}
 *Grade 1 and 2 tumors were classified as [[Neuroendocrine|neuroendocrine neoplasm]] (NET) and grade 3 were classified as neuroendocrine carcinoma (NEC).
-* In its new 8th edition of [[AJCC]] which is planned to be published on January 1, 2018; [[AJCC]] <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref> had developed a modified ENETS (mENETS) staging classification:
+* In its new 8th edition of [[AJCC]] which is planned to be published on January 1, 2018; [[AJCC]] had developed a modified ENETS (mENETS) staging classification:<ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref>
 {| class="wikitable" align="right"
-| '''Stage'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
-|'''T'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''T'''
-|'''N'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''N'''
-|'''M'''
+| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''M'''
 |-
-|IA
+| style="background:#DCDCDC;" align="center" + |IA
-|T1
+| style="background:#F5F5F5;" + |T1
-|N0
+| style="background:#F5F5F5;" + |N0
-|M0
+| style="background:#F5F5F5;" + |M0
 |-
-|IB
+| style="background:#DCDCDC;" align="center" + |IB
-|T2
+| style="background:#F5F5F5;" + |T2
-|N0
+| style="background:#F5F5F5;" + |N0
-|M0
+| style="background:#F5F5F5;" + |M0
 |-
-|IIA
+| style="background:#DCDCDC;" align="center" + |IIA
-|T3
+| style="background:#F5F5F5;" + |T3
-|N0
+| style="background:#F5F5F5;" + |N0
-|M0
+| style="background:#F5F5F5;" + |M0
 |-
-|IIB
+| style="background:#DCDCDC;" align="center" + |IIB
-|T1-3
+| style="background:#F5F5F5;" + |T1-3
-|N1
+| style="background:#F5F5F5;" + |N1
-|M0
+| style="background:#F5F5F5;" + |M0
 |-
-|III
+| style="background:#DCDCDC;" align="center" + |III
-|T4
+| style="background:#F5F5F5;" + |T4
-|Any N
+| style="background:#F5F5F5;" + |Any N
-| M0
+| style="background:#F5F5F5;" + |M0
 |-
-|IV
+| style="background:#DCDCDC;" align="center" + |IV
-|Any T
+| style="background:#F5F5F5;" + |Any T
-|Any N
+| style="background:#F5F5F5;" + |Any N
-|M1
+| style="background:#F5F5F5;" + |M1
 |}
 {| class="wikitable" style="text-align:center"
-|+'''mENETS'''
+| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" coolspan="4" + |'''mENETS'''
-! rowspan="4" | T
-| T1
-|Tumor limited to pancreas,<2 cm
 |-
-|T2
+! rowspan="4" style="background:#DCDCDC;" align="center" + |T
-|Tumor limited to pancreas,2-4 cm
+| style="background:#DCDCDC;" align="center" + |T1
+| style="background:#F5F5F5;" + |[[Tumor-associated calcium signal transducer 1|Tumor]] limited to [[pancreas]], <2 cm
 |-
-|T3
+| style="background:#DCDCDC;" align="center" + |T2
-|>4cm, or invading the duodenum or common bile duct
+| style="background:#F5F5F5;" + |[[Tumor]] limited to [[pancreas]], 2-4 cm
+|-
+| style="background:#DCDCDC;" align="center" + |T3
+| style="background:#F5F5F5;" + |>4cm, or invading the [[duodenum]] or [[common bile duct]]
 |-
-|T4
+| style="background:#DCDCDC;" align="center" + |T4
-|Tumor invades adjacent structures
+| style="background:#F5F5F5;" + |[[Tumor]] invades adjacent structures
 |-
-! rowspan="2" | N
+! rowspan="2" style="background:#DCDCDC;" align="center" + | N
-|N0
+| style="background:#DCDCDC;" align="center" + |N0
-|No regional lymph node metastasis
+| style="background:#F5F5F5;" + |No regional [[lymph node]] metastasis
 |-
-|N1
+| style="background:#DCDCDC;" align="center" + |N1
-|Regional lymph node metastasis
+| style="background:#F5F5F5;" + |Regional [[lymph node]] metastasis
 |-
-! rowspan="2" | M
+! rowspan="2" style="background:#DCDCDC;" align="center" + | M
-|M0
+| style="background:#DCDCDC;" align="center" + |M0
-|No distant metastasis
+| style="background:#F5F5F5;" + |No distant [[metastasis]]
 |-
-|M1
+| style="background:#DCDCDC;" align="center" + |M1
-|Distant metastasis
+| style="background:#F5F5F5;" + |Distant [[metastasis]]
 |-
 |}
 ==References==
-{{Reflist|1}}
+{{Reflist|2}}
+[[Category:Medicine]]
+[[Category:Endocrinology]]
+[[Category:Up-To-Date]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]