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In contrast, for L-NEN, prevalence of metastases in liver (19%), brain (9%), lung (7%) and bone (14%) was more equal. In the reference network cohort, slightly more NEN patients had metastatic disease (260/539, 48%) and similar metastatic patterns were observed. Conclusion Almost half of NEN patients were diagnosed with synchronous metastatic disease. L-NEN have a unique metastatic pattern compared to GE- and Pan-NEN. Remarkably, an important part of L-NEN metastases were in the brain, whereas brain metastases were almost absent in GE- an
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