Diagnostic pitfalls and unmet needs in neuroendocrine neoplasms: The added value of collegial expert pathology review through the national TENpath network
Abstract
Purpose: In some situations, the pathological diagnosis of neuroendocrine neoplasms (NEN) remains challenging, with direct consequences for treatment decisions. ENDOCAN-TENpath, the French national expert network for NEN pathology, established monthly virtual "third-reading" sessions for collegial review of difficult cases. We evaluated the diagnostic outcomes and clinical impact of this process. 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.
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BibTeX
@article{tihy2026diagnostic,
title = {{Diagnostic pitfalls and unmet needs in neuroendocrine neoplasms: The added value of collegial expert pathology review through the national TENpath network}},
author = {Matthieu Tihy and Jean-Yves Scoazec and Serge Guyétant and Mohamed-Amine Bani and Céline Bazille and Geneviève Belleannée and Christian Boissy and Camille Boulagnon-Rombi and Aurélie Cazes and Aurélie Charissoux and Marie-Pierrette Chenard and Marie Danjoux and Camille Darcha and Laurent Doucet and Charlotte Dufour and Antonin Fattori and Anne Guyot and Valérie Hervieu and Marie-Françoise Heymann and Catherine Julié and Thibault Kervarrec and Cosmin Lazaroiu and Emmanuelle Leteurtre and Laurent Martin and Stéphanie Patouraux and Flora Poizat and Nicolas Poté and Agathe Régnier and Benjamin Rivière and Magali Svrcek and Benoît Terris and Jérôme Cros and Anne Couvelard},
journal = {European Journal of Cancer},
year = {2026},
month = sep,
doi = {10.1016/j.ejca.2026.117018},
url = {https://hal.science/hal-05752715v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic pitfalls and unmet needs in neuroendocrine neoplasms: The added value of collegial expert pathology review through the national TENpath network
AU - Matthieu Tihy
AU - Jean-Yves Scoazec
AU - Serge Guyétant
AU - Mohamed-Amine Bani
AU - Céline Bazille
AU - Geneviève Belleannée
AU - Christian Boissy
AU - Camille Boulagnon-Rombi
AU - Aurélie Cazes
AU - Aurélie Charissoux
AU - Marie-Pierrette Chenard
AU - Marie Danjoux
AU - Camille Darcha
AU - Laurent Doucet
AU - Charlotte Dufour
AU - Antonin Fattori
AU - Anne Guyot
AU - Valérie Hervieu
AU - Marie-Françoise Heymann
AU - Catherine Julié
AU - Thibault Kervarrec
AU - Cosmin Lazaroiu
AU - Emmanuelle Leteurtre
AU - Laurent Martin
AU - Stéphanie Patouraux
AU - Flora Poizat
AU - Nicolas Poté
AU - Agathe Régnier
AU - Benjamin Rivière
AU - Magali Svrcek
AU - Benoît Terris
AU - Jérôme Cros
AU - Anne Couvelard
PY - 2026
DA - 2026/09/17
JO - European Journal of Cancer
DO - 10.1016/j.ejca.2026.117018
UR - https://hal.science/hal-05752715v1
AB - Purpose: In some situations, the pathological diagnosis of neuroendocrine neoplasms (NEN) remains challenging, with direct consequences for treatment decisions. ENDOCAN-TENpath, the French national expert network for NEN pathology, established monthly virtual "third-reading" sessions for collegial review of difficult cases. We evaluated the diagnostic outcomes and clinical impact of this process. 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.
SN - 0959-8049
ER -