Frequently Asked Questions

Below you will find answers to frequently asked questions about our mRNA diagnostic science, our NETest and other topics. If you have a question you would like to submit for our consideration, please contact us.

Neuroendocrine Tumors and the NETest

What are the signs & symptoms of NETs?

Flushing; frequent diarrhea (> 4 loose stools/day); wheezing; telangiecstasia (facial red spots); chronic abdominal cramping, pain and bloating; joint pain; fatigue.

What are the current diagnostic tests available to identify NETs?

Diagnosis of NETs is based on:

Clinical symptoms
Hormone levels – CgA; 5-HIAA (metabolite)
Radiological and nuclear imaging – CT
Histology – Ki67
Molecular – NETest (Wren Laboratories, LLC)

Is there a cure for NETs?

While some types of tumors have been evidenced not to metastasize, those are the exception to the rule. Predominantly there is no known cure for NETs.

What if I have an unknown primary? How do I manage my NETs?

It is of utmost importance that you partner with a NETs specialist in the management of your disease. When the primary is unknown, the focus of treatment(s) turn toward the metastatic disease. Therapies are then decided based on the site of metastasis; the clinical symptoms; the tumor burden (amount of tumor) as well as the staging, differentiation and activity of the metastatic disease.

Where may I find and access the most current literature?

Please visit our Resource Library for the most current literature.

How rare is this disease?

The incidents of NETs is 3.6/100,000 persons. It actually occurs as frequently as testicular cancer, Hodgkin’s Disease, gliomas (brain tumors) and multiple myeloma. (Modlin, et al, 2013) – The general professional consensus is that because NETs presents as so many other health disorders, and as such, causes misdiagnosis, the disease may not be as rare as previously thought.

What are the current conventional therapies available to NETs patients?

Surgical excision of tumor with resection of primary site
Radiofrequency ablation
Hepatic embolization (with chemo or bland spheres)
Chemotherapy
Octreotide analogs via injection

What studies are currently underway and how would I know they are right for me?

Yes, please contact Mark Kidd, PhD, DABCC or call 203-208-3464 for more information.

Is there such a thing as a surgical cure?

There have been cases of surgical removal of a Neuroendocrine Tumor (NET) tumor without further occurrence of the disease (i.e. appendix; ovary), however, it is very difficult for the surgeon to obtain “clear margins” when excising NETs as the disease usually remains present in the organ tissues at a molecular level.

Is there such a thing as a Neuroendocrine Tumor (NET) Center for Excellence?

Yes, please contact Mark Kidd, PhD, DABCC or call 203-208-3464 for more information.

NETest

How do I contact Wren Laboratories? (USA)

USAUSA Email:
info@wrenlaboratories.com

USA Phone:
203-208-3464

Who can use the tests?

Any European or US physician can order a test online. Once registered, European physicians can only order tests for patients in Europe. US physicians can only order tests for patients in the USA. If you are a physician interested in the test but are outside Europe or the USA, please contact us directly for advice on how to order the NETest.

When should a physician use the NETest?

The NETest was developed as an in vitro diagnostic that can be used to monitor neuroendocrine tumour disease. Physicians typically use the NETest to evaluate whether a patient has residual disease after surgery, to monitor patients during watch-and-wait programs and to test if a treatment is working. Please click this link to obtain an overview of when the NETest could be used during your patient journey.

Where are the tests available?

Throughout Europe and the USA. If you are a physician outside of Europe or the USA, please contact us directly for advice on how to order a test.

How do I contact Wren Laboratories? (Europe)

London Email: enquiries.europe@wrenlaboratories.com

London Phone:
+44 (0) 7454101915

Who should have a test?

The tests are undertaken in subjects with neuroendocrine tumour (NET) diseases who require an individualized assessment of disease risk. The test has been developed for all types of NET disease including stomach, lung, pancreas, appendix and bowel. Patients with a CUP can also use the test. Patients are usually 18 or older. In cases where someone is under 18, the ordering physician should discuss use with Wren Laboratories directly.

Are other tests available?

Wren Laboratories has also developed a test – the PPQ or PRRedicTor test – to predict the likelihood of a response to PRRT therapy. If you are interested in this, please contact us directly.

Is the test CE Marked? (Europe Only)

The NETest is not currently CE Marked and is made available exclusively on a Research Use Only basis.

Ordering

How do I order a test? (USA)

To order a test, please go to www.wrenlaboratories.com and click on the “Order a NETest” button. This will take you to a landing page. Please click on the “North American practitioners Click Here” button. This will take you to a page that will ask you to provide some details. Please fill in all fields including details for you and for your patient. It is very important to identify whether a kit will be sent to your office address or to the patient’s home address. Please ensure the correct button is clicked. There is also “CAPTCHA” icon at the bottom. Please fill this in and submit. This activates your test order. We will send you or your patient a kit (to the address you provided on registration).

How do I order a test after registering as a Wren Laboratories user? (Europe)

At www.wrenlaboratories.com enter the ordering site and login using your email and the password you chose at registration. This will open a page with options for ordering the NETest or the PPQ/PRRedicTor test. Chose the test and follow the instructions regarding patient information and payment. Please fill in all the required patient information. This is essential for the generation of an accurate test report. Once you have finished ordering the test online, we will email you a requisition form with your order as a .pdf. Please print out the order form which will include the test ordered, your details and the patient’s information. This form needs to be signed by you and included with the patient sample. It has a bar code (top right) that links the order to the sample and patient’s details. We will send you a kit (to the address you provided on registration) with the blood collection tube and instructions for collecting the blood sample and sending it to the laboratory for analysis. If you require tracking information for the kit, please request this directly from us and we will provide it.

How do I order a test? (Europe)

To order a test, you first need to register on the website. Please go to www.wrenlaboratories.com and click on the “Order a NETest” button. This will take you to a registration page. Please fill in your details including your address, to which the kit will be sent. Your email will be your login name. You will be asked to provide your own password. Please save both as these are user specific and are required for ordering the test. After you have set-up your account you will receive a registration confirmation email from us within 24-72 hrs. This will include a specific password (a mixture of numbers and letters) that we will provide you. You will need this password to open the patient reports. Once you have received confirmation you can order the test.

Can I order both a NETest and PPQ/PRRedicTor test for the same patient at the same time?

Yes, once you have finished ordering the NETest, you can then add the PPQ/PRRedicTor test. Please ensure the tumour grade is included when you order the PPQ. We will send you a separate email with a requisition form for the PPQ. Please note, you only need to collect one blood tube for both the NETest and PPQ test.

Kit Delivery and Storage

How is the kit sent to my office or my patient?

Each kit is sent using USPS and should arrive within 5 days of you ordering the test.

Can I change the address to which the kit is sent after I submit an order?

Unfortunately, as we try to ship the kit within 24hrs to the provided address, we cannot change the shipment address. Please contact our office if you need to re-order the test.*

*Potentially subject to a shipping fee

What can I do if I haven’t received my kit delivery?

If you haven’t received your package from us, please contact us directly.

How can the kit be stored?

Once you receive your kit package from us, please store at room temperature until the blood collection. The Wren RNA stabilization tube is stable and can be used until the tube expires (typically 6-12 months). Please check the tube label.

Blood Collection and Sendout

What is included in the kit?

Each kit includes a blood collection tube, instructions for collecting the blood sample, a requisition form that the physician will need to fill in and sign, a brief patient history form that needs completion, as well as instructions regarding sending it to the laboratory for analysis. If you require tracking information for the kit, please request this directly from us and we will provide it.

What if I have lost the collection instructions/patient form etc?

If you have misplaced the instructions for collection click here. If you have misplaced the kit or requisition forms please contact us.

How should the blood be collected and sent to the lab?

The instructions for collection are provided with the kit and can also be found here. At least 2 ml of blood should be drawn into the provided tube. Please include the appropriate patient identifiers on the tube. Once the collection is complete, either send the sample within 24 hours or freeze the sample at -80°C (NOT a normal refrigerator freezer) until send-out. Please send the sample on the same or on next day to the laboratory using the kit provided. Shipping is at ambient temperature. NO DRY ICE IS NEEDED. Please remember to include the order form that you signed in the kit.

If you are conducting a study and are collecting several patient samples over a period of time and want to batch send the samples in one delivery, please freeze all collected tubes in a -80°C freezer (NOT a normal refrigerator freezer). Samples should be frozen within 24 hrs of collection. Once sufficient samples are collected (e.g., 20), please send to the laboratory by courier at ambient temperature using the kit box provided.

Please click here to download the collection protocol.

What is needed to send a kit to Wren?

Each kit includes a pre-paid FEDEX label and a white polystyrene box.

Please ensure the blood sample is placed into the box.

Please include the box containing the blood sample tube, a fully completed and signed requisition form and the brief patient history form.

Please include any relevant clinical notes related to ordering the test (physician notes/clinical history).

Please call FEDEX, and they will send someone to your office to pick up the kit.

Testing Results

How is data processed?

The blood sample is processed and the neuroendocrine tumour gene expression quantified in laboratories in either the US or in the UK. The individual target gene data is processed using secure servers and proprietary algorithm analyses. The final output is provided in a report, as a score from 0-100 where 0 is the lowest risk and 100 is the highest risk.

What does the report mean?

The NETest report includes a number which is your patient’s score. This ranges from 0 to 100. Scores from 0-20 fall into the normal category. Scores that range 21-40 fall into the stable disease category. Scores from 41-100 fall into the progressive disease category. Literature about the NETest, how it was developed and how it provides clinical utility is included in your report. Click here for a sample of the NETest report.

How will I receive the result?

The result will be sent to you, the ordering physician, by secure email. If you do not receive the result, a hardcopy can be sent to you via USPS. If you have not received a patient report, please contact us directly.

How accurate are the results?

The NETest score has been validated in thousands of patients and published in over 20 articles. The overall accuracy as a diagnostic is 96%. Articles about the NETest are included on the Wren website. To access them, click here. The PPQ test has been recently developed and demonstrated to be 94-99% accurate for predicting a response to PRRT. Articles about the PPQ test are included on the Wren website. To access them, click here then select the PRRedicTor tab.

Feedback

Where can I leave feedback?

Feedback can be done via phone, email or on GOOGLE reviews. To access GOOGLE reviews, you will need a gmail account.