{"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":1772160709855,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Neuroendocrinology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In patients with gastroenteric and pancreatic neuroendocrine neoplasms (GEP\u2010NENs), the risk of liver metastases is high, but the accuracy of standard imaging for detecting small hepatic nodules is limited. This raises concerns about the adequacy of staging in cM0 patients. This study aims to determine the percentage of cM0 GEP\u2010NEN patients with occult liver metastases that can be identified using intraoperative ultrasound (IOUS) during surgery for the primary tumor. A prospective study was conducted at three high\u2010volume centers between October 2020 and December 2023. Patients who underwent surgery for GEP\u2010NENs staged as cM0 based on CT and PET\/CT (MRI in selected cases) were included. IOUS was systematically performed, in combination with contrast\u2010enhanced IOUS (CE\u2010IOUS) and biopsy when necessary. The ground truth was the result of a contrast\u2010enhanced CT or MRI performed 6 months after surgery. A total of 51 cM0 GEP\u2010NEN patients were enrolled. IOUS detected suspicious liver nodules in seven patients (14%). Three were classified as metastatic based on the IOUS pattern, CE\u2010IOUS pattern, and biopsy, respectively, while four were classified as non\u2010metastatic based on biopsy (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092) or CE\u2010IOUS pattern (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092). At six\u2010month follow\u2010up imaging, two patients (4%) were confirmed as metastatic (the suspicious metastasis at CE\u2010IOUS was not confirmed). GEP\u2010NENs G3 and those with necrosis had a higher risk of metastases (one\u2010third of patients,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05 compared to G1\u20102 and non\u2010necrotic neoplasms). IOUS, combined with CE\u2010IOUS and biopsy, achieved 100% sensitivity, 98% accuracy, and 100% negative predictive value. IOUS, along with CE\u2010IOUS and biopsy, provides accurate staging in GEP\u2010NENs, identifying occult metastases in approximately 4% of cM0 cases. Due to the low incidence of occult metastases, routine use of IOUS cannot be recommended. It should be considered selectively in aggressive tumors, which have shown a significantly higher risk of liver involvement.\n                  <\/jats:p>","DOI":"10.1111\/jne.70079","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T23:49:32Z","timestamp":1755560972000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative hepatic ultrasonography in patients with gastrointestinal and pancreatic neuroendocrine neoplasms without preoperative evidence of liver metastases"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4108-4832","authenticated-orcid":false,"given":"L.","family":"Vigan\u00f2","sequence":"first","affiliation":[{"name":"Hepatobiliary Unit, Department of Minimally Invasive General &amp; Oncologic Surgery Humanitas Gavazzeni University Hospital  Bergamo Italy"},{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Maruccio","sequence":"additional","affiliation":[{"name":"Hepatobiliary Unit, Department of Minimally Invasive General &amp; Oncologic Surgery Humanitas Gavazzeni University Hospital  Bergamo Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Faustini","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Unit Pancreas Institute, Policlinico GB Rossi University of Verona Hospital Trust  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Frigerio","sequence":"additional","affiliation":[{"name":"HPB Unit Pederzoli Hospital  Verona Italy"},{"name":"Collegium Medicum, University of Social Sciences  \u0141odz Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Gavazzi","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery Unit IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"De Robertis Lombardi","sequence":"additional","affiliation":[{"name":"Unit of Radiology Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Scopelliti","sequence":"additional","affiliation":[{"name":"HPB Unit Pederzoli Hospital  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Capretti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"},{"name":"Pancreatic Surgery Unit IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-053X","authenticated-orcid":false,"given":"A.","family":"Ammirabile","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"},{"name":"Department of Radiology IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"D'Onofrio","sequence":"additional","affiliation":[{"name":"Unit of Radiology Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Giardino","sequence":"additional","affiliation":[{"name":"HPB Unit Pederzoli Hospital  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Ferrillo","sequence":"additional","affiliation":[{"name":"Department of Radiology IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Rodari","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Regi","sequence":"additional","affiliation":[{"name":"HPB Unit Pederzoli Hospital  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Procopio","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"},{"name":"Division of Hepatobiliary and General Surgery IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Salvia","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Unit Pancreas Institute, Policlinico GB Rossi University of Verona Hospital Trust  Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Lania","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Milan Italy"},{"name":"Endocrinology, Diabetology and 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