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The Role of Endoscopic Ultrasound-Guided Ki67 in The Management of Non-Functioning Pancreatic Neuroendocrine Tumors

Clinical Endoscopy 2020년 53권 2호 p.213 ~ 220
Cui Yong Yan, Khanna Lauren G., Saqi Anjali, Crapanzano John P., Mitchell James M., Sethi Amrita, Gonda Tamas A., Kluger Michael D., Schrope Beth A., Allendorf John, Chabot John A., Poneros John M.,
소속 상세정보
 ( Cui Yong Yan ) - New York Presbyterian Columbia University Irving Medical Center Department of Medicine
 ( Khanna Lauren G. ) - New York University Department of Medicine
 ( Saqi Anjali ) - New York Presbyterian Columbia University Irving Medical Center Department of Pathology and Cell Biology
 ( Crapanzano John P. ) - New York Presbyterian Columbia University Irving Medical Center Department of Pathology and Cell Biology
 ( Mitchell James M. ) - New York Presbyterian Columbia University Irving Medical Center Department of Pathology and Cell Biology
 ( Sethi Amrita ) - New York Presbyterian Columbia University Irving Medical Center Department of Medicine
 ( Gonda Tamas A. ) - New York Presbyterian Columbia University Irving Medical Center Department of Medicine
 ( Kluger Michael D. ) - New York Presbyterian Columbia University Irving Medical Center Department of Surgery
 ( Schrope Beth A. ) - New York Presbyterian Columbia University Irving Medical Center Department of Surgery
 ( Allendorf John ) - New York University Winthrop Hospital Department of Surgery
 ( Chabot John A. ) - New York Presbyterian Columbia University Irving Medical Center Department of Surgery
 ( Poneros John M. ) - New York Presbyterian Columbia University Irving Medical Center Department of Medicine

Abstract


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.

키워드

Nonfunctioning; Neuroendocrine; Concordance; Ki67

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