{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:51:49Z","timestamp":1772160709956,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Neuroendocrinology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Small intestine neuroendocrine tumours (SI\u2010NETs) are often diagnosed late with a UK median of 3\u2009years and high misdiagnosis rates. Previous studies, largely based on patient surveys, offer little data on improving diagnosis. In 2017, the South Wales NET service underwent a nationally commissioned, systematic transformation, aiming to improve diagnosis through the development of a gastroenterology and surgical referral network, and education of these specialities. This study aims to assess the impact of the transformation on SI\u2010NET diagnosis times and misdiagnosis rates using accurate hospital data, along with the diagnostic routes and investigations used for SI\u2010NETs. We retrospectively analysed the hospital records of 224 patients diagnosed with SI\u2010NETs referred to the South Wales NET service (110 pre\u2010transformation and 114 post\u2010transformation). Following the service transformation, there was a significant reduction in diagnosis times from a median of 12.5\u20135.2\u2009months (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.05), at an earlier stage (cases with metastases reduced from 77% to 62%), and reduced misdiagnosis rates from 40% to 25%. Colonoscopy, used to investigate the presenting gastrointestinal symptoms in 42% of patients prior to diagnosis, identified an abnormality in only 28%, compared with 97% with computed tomography (CT) scans. A gastroenterology and surgical referral network across hospitals may improve diagnosis in SI\u2010NETs, leading to earlier detection and reducing misdiagnosis rates. Further exploration of GP interactions is needed. Caution is needed following negative colonoscopy in patients with persistent lower gastrointestinal symptoms as this could lead to missed SI\u2010NET diagnosis if further abdominal imaging is not undertaken.\n                  <\/jats:p>","DOI":"10.1111\/jne.13486","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T01:08:23Z","timestamp":1735261703000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Earlier diagnosis of small intestine neuroendocrine tumours (\n                    <scp>SI<\/scp>\n                    \u2010\n                    <scp>NETs<\/scp>\n                    ) through transformation of the South Wales\n                    <scp>NET<\/scp>\n                    service"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4094-6734","authenticated-orcid":false,"given":"Harriet L.","family":"Gould","sequence":"first","affiliation":[{"name":"Cardiff University  Cardiff UK"},{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kapish","family":"Amin","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"},{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanos","family":"Karategos","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Abbas","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susannah","family":"Olive","sequence":"additional","affiliation":[{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathoorika","family":"Sivananthan","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayeesha","family":"Rela","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harriet","family":"Reed","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Powell","sequence":"additional","affiliation":[{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4569-5761","authenticated-orcid":false,"given":"Janu","family":"Navaratnam","sequence":"additional","affiliation":[{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rwth","family":"Ellis\u2010Owen","sequence":"additional","affiliation":[{"name":"Department of Radiology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Fielding","sequence":"additional","affiliation":[{"name":"Department of Radiology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipanjali","family":"Mondal","sequence":"additional","affiliation":[{"name":"Department of Radiology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Kihara","sequence":"additional","affiliation":[{"name":"South Wales Neuroendocrine Tumour Service Swansea Bay University Health Board  Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gethin","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Surgery Royal Gwent Hospital  Newport UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carys","family":"Morgan","sequence":"additional","affiliation":[{"name":"Velindre Cancer Centre  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justyna","family":"Witczak","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Cornish","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Gwynne","sequence":"additional","affiliation":[{"name":"South Wales Neuroendocrine Tumour Service Swansea Bay University Health Board  Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Horwood","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared","family":"Torkington","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Hargest","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"},{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Christian","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Davies","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Ansell","sequence":"additional","affiliation":[{"name":"Surgical Directorate Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohid S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"},{"name":"South Wales Neuroendocrine Tumour Service, Department of Gastroenterology Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-019-0606-3"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-5057-3"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000818"},{"key":"e_1_2_10_5_1","article-title":"Patient\u2010reported time to diagnosis of neuroendocrine tumors (NETs) in Europe: results from the first global NET patient survey: a collaboration between the International Neuroendocrine Cancer Alliance (INCA) and Novartis","volume":"37","author":"Pavel M","year":"2015","journal-title":"Endodrine 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Available from:https:\/\/www.bsg.org.uk\/clinical\u2010resource\/neuroendocrine\u2010tumours\u2010nets\u2010improvements\u2010in\u2010service\u2010provision\u2010for\u2010wales\/"},{"issue":"1","key":"e_1_2_10_9_1","first-page":"1","article-title":"Improving patient outcomes: development of a patient\u2010centred service for neuroendocrine tumours in Wales through population\u2010based National Commissioning","volume":"108","author":"Khan MS","year":"2019","journal-title":"Neuroendocrinology"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000488510"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2020-101431"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.0589"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.15.4377"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2022.40.4_suppl.502"},{"key":"e_1_2_10_15_1","volume-title":"Improving Diagnosis in Health Care","author":"Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences E, and Medicine","year":"2015"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2020.03.002"},{"issue":"11","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-055488","article-title":"Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review","volume":"11","author":"George NO","year":"2021","journal-title":"BMJ Open"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2022-327985"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3273"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jne.13196"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02564-2"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01393-4"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9113633"}],"container-title":["Journal of Neuroendocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jne.13486","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T23:44:12Z","timestamp":1744069452000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jne.13486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,26]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/jne.13486"],"URL":"https:\/\/doi.org\/10.1111\/jne.13486","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/JNE.13486\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JNE.13486\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JNE.13486\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JNE.13486\/v1\/review1","asserted-by":"object"}]},"ISSN":["0953-8194","1365-2826"],"issn-type":[{"value":"0953-8194","type":"print"},{"value":"1365-2826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,26]]},"assertion":[{"value":"2024-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13486"}}