To test whether MAD+ PANETs in our cohort exhibited ALT phenotype as reported by Jiao et al. [45, 48], we compared the overall length of telomeres between 13 PANETs and 10 MAD− GINETs (gastrointestinal neuroendocrine tumors) using sWGS. Here, GPT is linked to digestive system neuroendocrine tumor, grade 1/2.