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We’re bringing you a real world action plan for your patients with von Hipple-Lindau (VHL) germline mutations. Turns out they have pretty unique prognoses when it comes to pancreatic neuroendocrine tumors (PNET). This prospective--you heard us--study of VHL patients with radiographic PNET lesions demonstrates that among 83 (of 175 total) patients who had small (<1.2 cm) lesions, all were safely managed with interval imaging alone. What’s more, this surveillance imaging was performed only about every 2-3 years. This means almost half of VHL-associated PNETs required no invasive intervention, like, ever. Ok, at least over the median 4.5 years of follow-up. This is another great example of individualizing de-escalations of therapy.