NEN: Advancement in Diagnosis and Minimally Invasive Therapy

Neuroendocrine neoplasms (NEN) are a heterogeneous type of malignant disease and frequently present with symptoms caused by the secretion of metabolically active substances or the manifestation of distant metastases, with the liver being the most frequent site of spreading. Early diagnosis of metastatic disease is recognized as the major prognostic factor in NEN patients. Complete surgical resection is feasible in only selected cases. For patients with unresectable liver metastases, various locoregional treatment approaches are available. Over the last decade, therapeutic procedures including locoregional and systemic treatments have been investigated for gastroenteropancreatic NEN (GEP-NEN), especially for metastatic disease to the liver. Only a few prospective clinical trials have compared these approaches, and the management of individual patients remains subject to clinical expertise and judgement. Locoregional treatments are applicable in patients with limited metastatic involvement of the liver, and may be used for tumor debulking and symptom control in patients with diffuse liver involvement. KEY POINTS:: · Neuroendocrine Neoplasms (NENs) represent a heterogeneous class of rare malignancies.. · Surgery is the treatment of choice for primary non-metastatic NEN.. · The liver is the most frequently affected site by neuroendocrine metastases.. · In limited metastastic liver disease local curative treatment may be accomplished by surgical resection or percutaneous thermal ablation.. · Multi-probe stereotactic thermal ablation with image fusion for intraoperative evaluation of a sufficient safety margin allows for safe and effective treatment of large liver metastases.. CITATION FORMAT: · Putzer D, Schullian P, Jaschke W et al. NET: Neue Entwicklungen in Diagnostik und minimalinvasiver Therapie. Fortschr Röntgenstr 2020; 192: 422 - 430.