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Follow-up of Neuroendocrine Tumors

Follow-up of Neuroendocrine Tumours:

Low-risk Resected Disease

  • All of the following: primary less than 2 cm, no nodal involvement, and low Ki67 index (<5%)
  • Low risk of recurrence
  • Routine surveillance imaging or lab work is not recommended.  Clinical follow up at the discretion of the treating physician.
High-risk Resected Disease

  • Surveillance per the table below if any of the following high risk features: primary greater than 2 cm, nodal involvement, high Ki67 (≥5%)
  • If high risk and grade 3 disease – period of recommended follow-up is 5 years
  • If high risk and grade 1-2 – period of recommended follow-up is 10 years 
Test
Year 1
Years 2-10
5-HIAA (if functional)
not recommended
not recommended
Chromogranin A
not recommended
not recommended
CT scan
annually
annually
Nuclear Medicine imaging
if any of the above are abnormal

Post-debulking with no visible residual disease

Test
Year 1
Years 2-3
Year 4-5
5-HIAA (if  functional)
every 3–6  months
every 6 months
annually
Chromogranin A
every 3–6 months
every 6 months
annually
CT scan
annually
annually
annually
Octreotide or MIBG scan
if any of the above are abnormal
if any of the above are abnormal
if any of the above are abnormal

Unresected disease (metastatic or residual-positive post-debulking)

Test
Year 1
Years 2-5
5-HIAA (if functional)
every 3–6 months
every 4–6 months
Chromogranin A
every 3 months
every 4–6 months
CT scan
every 6 months
every 6 months – 1 year per clinical discretion
Octreotide or MIBG scan
if any of the above are abnormal
if any of the above are abnormal
Echocardiogram
annually if 5-HIAA is over 70 mg/24 hours
annually if 5-HIAA is over 70 mg/24 hours

SOURCE: Follow-up of Neuroendocrine Tumors ( )
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