Gastroenteropancreatic Neuroendocrine Tumors

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 25, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.50
Procedures: 2.50
Abdomen and Pelvis: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Body: 2.50

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Endocrine and Oncology Procedures: 2.50

Registered Radiologist Assistant: 3.75
Procedures: 3.75
Abdominal Section: 3.75

Sonography: 2.50
Procedures: 2.50
Abdomen: 2.50

Radiation Therapy: 4.00
Patient Care: 2.00
Patient and Medical Record Management: 2.00
Procedures: 2.00
Treatment Sites and Tumors: 2.00

Outline

1. Introduction
2. Risk Factors and Etiology
3. Diagnosis
4. Pathologic Classification and Staging
5. Imaging Techniques
   1. Noninvasive Techniques: Morphologic Imaging
   2. Noninvasive Techniques: Functional Imaging
   3. Invasive Techniques
6. Role of Imaging in Tumor Detection and Characterization
   1. Pancreatic NETs
   2. Extrapancreatic NETs
7. Detection of Unknown Primary NETs
8. Imaging in Metastatic Disease
9. Treatment
10. Follow-up
11. Screening in High-Risk Patients with Genetic Defects
12. Conclusions

Objectives

Upon completion of this course, students will:

1. understand the difference between the terms prevalence and incidence
2. understand why prevalence is the preferred statistic when the focus is on the overall number of cases surviving in a population
3. understand how the divisions of the gastrointestinal tract are delineated
4. identify the divisions of the gastrointestinal tract
5. be familiar with the GEP-NET geographic distribution throughout the world
6. know the GI tract location having the highest percentage of NET occurrence
7. identify the essential process(es) involved with GEP-NET management and treatment planning
8. be familiar with the tumor suppression proteins of the complex genetic syndromes associated with GEP-NETs
9. be familiar with the genes of the complex genetic syndromes associated with GEP-NETs
10. identify the possible patient problems from Zollinger-Ellison syndrome
11. be familiar with the most commonly used neuroendocrine serum marker for GEP-NET diagnosis
12. know how the various proton-pump inhibitors differ
13. be familiar with the initial WHO tumor classification criteria
14. know the ENETS tumor classification criteria
15. be familiar with TNM staging for pancreatic NETs
16. be familiar with TNM staging for NETs of the stomach, small intestine, colon, and rectum
17. be familiar with the methods of Ki-67 analysis
18. know the required components for appropriate care of GEP-NET patients
19. know the general limitation of trans-abdominal ultrasound in pancreas evaluations
20. identify the reasons for multi-detector CT being the most common initial imaging test to evaluate for suspected pathologic conditions in the abdomen
21. know the advantages of MR imaging over CT imaging
22. identify the somatostatin analog considered to be the reference standard for NET functional imaging
23. understand the recognized limitations of SRS
24. be familiar with advantages of PET somatostatin analog imaging over SRS
25. know where FDG PET has limited value in NET evaluation
26. be familiar with the drawbacks of endoscopic ultrasound for NET evaluations
27. know the term for the process of separating a disease from others having similar signs and symptoms
28. understand the heat-damaged ^99mTc red blood cell procedure for functional imaging of accessory spleen tissue
29. be familiar with the differences of functional and nonfunctional pancreatic NETs
30. be familiar with how aggressive nonfunctional pancreatic NETs demonstrate
31. be familiar with how pancreatic NETs appear on MR imaging
32. know what procedure can benefit in IPAS diagnosis when MR fails
33. know the procedure that can be the most sensitive for pancreatic NET detection
34. be familiar with the reasons why preoperative detection of a primary NET in the gastrointestinal tract is challenging
35. be familiar with the different types of gastric NETs
36. identify the best contrast medium for visualizing type I and II gastric NETs on contrast-enhanced CT imaging
37. know the roles that endoscopy and biopsy play in duodenal NETs
38. be familiar with how Ileal NETs manifest on CT/MR enterography
39. be familiar with some difficult differential diagnosis for ileal NETs
40. be familiar with the features and manifestations of colon NETs
41. identify the most common sites for NET metastases
42. know the single most important factor for small bowel NETs that influences patient survival and prognosis
43. identify the factors which improve the detection and characterization ability of MR imaging for malignant liver lesions
44. identify the situation in which radical surgery along with resection of draining lymph nodes is recommended
45. be familiar with the GEP-NET screening methods for high-risk patients with genetic defects