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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 concor...

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Autores principales: Cui, YongYan, 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Gastrointestinal Endoscopy 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137561/
https://www.ncbi.nlm.nih.gov/pubmed/31302988
http://dx.doi.org/10.5946/ce.2019.068
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author Cui, YongYan
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.
author_facet Cui, YongYan
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.
author_sort Cui, YongYan
collection PubMed
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.
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spelling pubmed-71375612020-04-10 The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors Cui, YongYan 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. Clin Endosc Original Article 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. Korean Society of Gastrointestinal Endoscopy 2020-03 2019-07-15 /pmc/articles/PMC7137561/ /pubmed/31302988 http://dx.doi.org/10.5946/ce.2019.068 Text en Copyright © 2020 Korean Society of Gastrointestinal Endoscopy This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Cui, YongYan
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.
The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors
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 Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137561/
https://www.ncbi.nlm.nih.gov/pubmed/31302988
http://dx.doi.org/10.5946/ce.2019.068
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