Non-functional neuroendocrine tumors of the pancreas: Advances in diagnosis and management

Figure 1 Representative images of the 5 types of pancreatic neuroendocrine tumor enhancement pattern on arterial phase computed tomography. Two images are shown for each type. A: Hyperenhancing, solid; B: Cystic with hyperenhancing rim; C: Isoenhancing or no mass visualized; D: Homogeneously hypoenhancing; E: Heterogeneous but mostly hypoenhancing with some peripheral enhancement. Groups D and E had worse survival after resection compared with groups A, B, and C (From Worhunsky et al[35]. Pancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness. HPB 2014; 16: 304-311). Arrows indicate PNET.

Figure 2 Axial computed tomography images of Pancreatic neuroendocrine tumor with punctate (A, C) and dense/coarse calcifications (B, D). Despite their small size, all lesions were associated with either lymph node metastasis (A-C) or intermediate (G2) grade (B-D) on pathologic evaluation (From Poultsides et al[36]. Pancreatic Neuroendocrine Tumors: Radiographic Calcifications Correlate with Grade and Metastasis. Ann Surg Onc 2012; 19: 2295-2303).

Figure 3 Results of the Clarinet trial which randomized patients with enteropancreatic neuroendocrine tumors to lanreotide vs placebo. From: Caplin et al[80]. Lanreotide in Metastatic Enteropancreatic Neuroendocrine Tumors. N Engl J Med 2014; 371: 224-233.

Figure 4 Results of the RADIANT-3 trial which randomized patients with nonfunctional neuroendocrine tumors of the pancreas to Everolimus vs placebo. From Yao et al[94]. Everolimus for Advanced Pancreatic Neuroendocrine Tumors. N Engl J Med 2011; 364: 514-523.

Figure 5 Results of a randomized controlled trial of Sunitinib vs placebo for well-differentiated pancreatic neuroendocrine tumors demonstrating (A) progression free survival and (B) overall survival. From: Raymond et al[98]. Sunitinib Malate for the Treatment of Pancreatic Neuroendocrine Tumors. N Engl J Med 2011; 364: 501-513.