Blood Tests in Patients with NETs:  

Bloodwork 101 (Guide from ISI):  Patient guide for blood tests; see Chapter 4 starting on Page 107.

  1. Note section on 5-HIAA Plasma test as an alternate test to the 24 hour HIAA urine collection.

  2. Neurokinin A (NKA) has been shown to be a powerful independent predictor of a poor prognosis in well-differentiated midgut NETs.  Patients with NKA levels below 50 pg/mL have an excellent 3 year survival rate compared to patients with values over 50.

  3. Pancreastatin is a fragment of the chromogranin A molecule and may be a more sensitive predictor of carly changes in tumor burden compared to chromogranin A.

Pathology Report in Patients with NETS - You should know your KI-67 Index:

The diagnosis of a NET primarily depends on microscopic analysis of a tissue sample obtained from a tumor.  The tissue may be obtained by a needle biopsy or from a surgical biopsy or excision. Once the pathologist confirms the diagnosis of a NET, an additional analysis is performed to determine the Ki-67 index of the tumor, a measure of the number of cells in a tumor that are dividing (proliferating).  The Ki-67 Index determines the tumor Grade which is important for understanding the potential tumor growth rate and as a factor making treatment decisions.

Ki-67 Categories in NETs:

Grade 1: <3

Grade 2: 3-30

Grade 3: >30

Grades 1 and 2 are considered “low grade”; Grade 3 is “high grade” and these are called neuroendocrine carcinomas. The approach to imaging and treatment are different for Grade 3 NETs.