Diagnostic pitfalls and unmet needs in neuroendocrine neoplasms: The added value of collegial expert pathology review through the national TENpath network.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tihy Matthieu, Scoazec Jean-Yves, Guyétant Serge, Bani Mohamed-Amine, Bazille Céline, Belleannée Geneviève, Boissy Christian, Boulagnon-Rombi Camille, Cazes Aurélie, Charissoux Aurélie, Chenard Marie-Pierrette, Danjoux Marie, Darcha Camille, Doucet Laurent, Dufour Charlotte, Fattori Antonin, Guyot Anne, Hervieu Valérie, Heymann Marie-Françoise, Julié Catherine, Kervarrec Thibault, Lazaroiu Cosmin, Leteurtre Emmanuelle, Martin Laurent, Patouraux Stéphanie, Poizat Flora, Poté Nicolas, Régnier Agathe, Rivière Benjamin, Svrcek Magali, Terris Benoît, Cros Jérôme, Couvelard Anne
Аннотация
METHODS: All cases submitted to third-reading sessions from March 2022 to December 2023 were retrospectively reviewed. We analyzed diagnostic difficulties, diagnostic modifications, and their expected therapeutic impact.
RESULTS: Of 3239 cases received by ENDOCAN-TENpath, 126 (3.9%) were submitted to third-reading by 22 of 33 network pathologists (median turnaround: 20 days). Diagnostic difficulties fell into four categories: high-grade NEN classification (33.3%), mixed neuroendocrine/non-neuroendocrine neoplasm diagnosis (36.5%), incomplete neuroendocrine phenotypes (23.0%), and unfamiliar entities (7.1%). Consensus or majority diagnosis was reached in 102 cases (81%). Unresolved cases were due to lack of consensus (n = 13) or insufficient material (n = 10). Critically, the process yielded decisions with major therapeutic consequences: 20/46 presumed NENs were reclassified as non-neuroendocrine malignancies and 5/25 presumed adenocarcinomas as NENs, fundamentally altering treatment strategy. Furthermore, 32/42 ambiguous high-grade NENs were definitively classified as tumor or carcinoma, directly determining first-line chemotherapy regimen. These findings also prompted internal guidelines to reduce diagnostic variability.
CONCLUSION: The ENDOCAN-TENpath third-reading process yields a high rate of clinically actionable diagnostic decisions directly altering treatment strategy, while identifying unmet needs and providing a framework for reducing diagnostic variability in complex NEN cases.