The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors
Background/Aims The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concord...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2020-03-01
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| Series: | Clinical Endoscopy |
| Subjects: | |
| Online Access: | http://www.e-ce.org/upload/pdf/ce-2019-068.pdf |
| _version_ | 1827612719038070784 |
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| author | YongYan Cui Lauren G. Khanna Anjali Saqi John P. Crapanzano James M. Mitchell Amrita Sethi Tamas A. Gonda Michael D. Kluger Beth A. Schrope John Allendorf John A. Chabot John M. Poneros |
| author_facet | YongYan Cui Lauren G. Khanna Anjali Saqi John P. Crapanzano James M. Mitchell Amrita Sethi Tamas A. Gonda Michael D. Kluger Beth A. Schrope John Allendorf John A. Chabot John M. Poneros |
| author_sort | YongYan Cui |
| collection | DOAJ |
| description | Background/Aims The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NF-PNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. Methods We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NF-PNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. Results There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordance was the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028) were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumor size >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. Conclusions NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs with intermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUS-FNA can be monitored without surgical intervention, up to tumor size 20 mm. |
| first_indexed | 2024-03-09T08:28:25Z |
| format | Article |
| id | doaj.art-16485019b4044d938169bbf885ec257b |
| institution | Directory Open Access Journal |
| issn | 2234-2400 2234-2443 |
| language | English |
| last_indexed | 2024-03-09T08:28:25Z |
| publishDate | 2020-03-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj.art-16485019b4044d938169bbf885ec257b2023-12-02T20:36:43ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432020-03-0153221322010.5946/ce.2019.0687240The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine TumorsYongYan Cui0Lauren G. Khanna1Anjali Saqi2John P. Crapanzano3James M. Mitchell4Amrita Sethi5Tamas A. Gonda6Michael D. Kluger7Beth A. Schrope8John Allendorf9John A. Chabot10John M. Poneros11 Department of Medicine, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Division of Gastroenterology and Hepatology, Department of Medicine, New York University, New York, NY, USA Department of Pathology and Cell Biology, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Department of Pathology and Cell Biology, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Department of Pathology and Cell Biology, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Department of Surgery, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Department of Surgery, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Department of Surgery, New York University Winthrop Hospital, Mineola, NY, USA Department of Surgery, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USA Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Irving Medical Center, New York, NY, USABackground/Aims The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NF-PNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. Methods We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NF-PNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. Results There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordance was the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028) were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumor size >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. Conclusions NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs with intermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUS-FNA can be monitored without surgical intervention, up to tumor size 20 mm.http://www.e-ce.org/upload/pdf/ce-2019-068.pdfconcordanceki67neuroendocrinenonfunctioning |
| spellingShingle | YongYan Cui Lauren G. Khanna Anjali Saqi John P. Crapanzano James M. Mitchell Amrita Sethi Tamas A. Gonda Michael D. Kluger Beth A. Schrope John Allendorf John A. Chabot John M. Poneros The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors Clinical Endoscopy concordance ki67 neuroendocrine nonfunctioning |
| title | The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors |
| title_full | The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors |
| title_fullStr | The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors |
| title_full_unstemmed | The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors |
| title_short | The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors |
| title_sort | role of endoscopic ultrasound guided ki67 in the management of non functioning pancreatic neuroendocrine tumors |
| topic | concordance ki67 neuroendocrine nonfunctioning |
| url | http://www.e-ce.org/upload/pdf/ce-2019-068.pdf |
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