Patrick Starlinger_TELL International

How does somatostatin PET perform in detecting nodal metastases in patients with pancreatic NETs evaluated for resection? Not so great... 130 patients w/ pNETs who all had SSTR PET followed by resection. 42% had path proven LN mets but only 24% were seen preop on PET (sensitivity 46%). Specificity much better, 92% with PPV of 81% and NPV of only 29%. As expected, larger nodes and a higher Krenning score were more likely to be found on SSTR PET. Be careful with multifocal pNETs such as in MEN1 as multifocality can resemble nodal mets. @TELL_Starlinger @ThielsCA @PackardAnnie @MayoRadiology @MayoClinicSurg @MayoCancerCare @MayoHemeOnc sciencedirect.com/science/ar…

Last commute of the year… and a cold one. Thanks for 2025 and try to be nice to your fellow human travelers in 2026 and onwards. Embrace kindness and reject hate! Ultimately, we will all shuffle off this mortal coil so why not try to make an effort to be kinder while here…?

Another excellent paper from @vanjapod, @TELL_Starlinger and the Mayo Team. Time to split up the grade 2 for pNETs in G2a and G2b. G2b has inferior outcomes compared to G2a in those with non-metastatic pNETs. Interestingly, this is not apparent following resection of liver mets. link.springer.com/article/10…

Clinically useful papers to help predict outcomes following curative intent resection of NETs are extremely helpful for clinicians counseling patients. This is one such paper you should read if you take care of patients with pancreatic NETs. A large study (770 patients) looking at recurrence risk following resection of lymph node negative pNETs. Overall recurrences in almost 11% of resected patients, but factors such as larger tumors, higher grade, and lymphovascular invasion predicted increased recurrence risk. 3 risk categories (low, moderate, and high risk of recurrence) predicted recurrence -- 2.4%, 9%, and 27.7%. Easy to apply in clinic. Some info provided on mutations but more data on that are needed. Excellent work! jamanetwork.com/journals/jam…

Should primary pancreatic NETs be resected at the time of hepatic debulking in asymptomatic patients with metastatic pNETs? Perhaps not... In this retrospective study, no significant difference in overall survival whether primary tumor was removed or not link.springer.com/article/10…

The prognostic role of tumor progression prior to resection of NET hepatic metastases. Analysis of 383 patients undergoing resection of well-differentiated NETLM. Preoperative hepatic tumor progression a strong independent predictor of early mortality following hepatic debulking. Patients with stable disease did much better, similar outcomes in pNETs and siNETs. sciencedirect.com/science/ar…