The dilemma of “indeterminate” interpretations of pancreatic neuroendocrine tumors on fine needle aspiration

Ahmed, Aadil; VandenBussche, Christopher; Ali, Syed Z.; Olson, Matthew T.

doi:10.1002/dc.23333

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…However, as current guidelines require histological assessment of the tumor tissue in order to properly grade a NEN, a core-needle biopsy is strongly recommended [6,15]. Indeed, even though the value of FNAB is not to be entirely neglected [16][17][18], the literature supports the use of CNB rather than FNAB when assessing NENs (both primary and metastatic) [19][20][21][22]. In CNB material, the Ki-67 index can usually be established by counting at least 2000 cells in hotspot areas, and other advantages include the possibility to perform immunohistochemistry to pinpoint the tumoral origin, a possible hormone production, the SSTR status, and potentially the PD-L1 status before considering eventual adjuvant treatment.…”

Section: The Core-needle Biopsy: Advantages To Fine-needle Aspiration...mentioning

confidence: 99%

Metastatic Neuroendocrine Neoplasms of Unknown Primary: Clues from Pathology Workup

Juhlin

Zedenius

Höög

2022

Cancers

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Neuroendocrine neoplasms (NENs) are diverse tumors arising in various anatomical locations and may therefore cause a variety of symptoms leading to their discovery. However, there are instances in which a NEN first presents clinically as a metastatic deposit, while the associated primary tumor is not easily identified using conventional imaging techniques because of small primary tumor sizes. In this setting (which is referred to as a “NEN of unknown primary”; NEN-UP), a tissue biopsy is often procured to allow the surgical pathologist to diagnose the metastatic lesion. If indeed a metastatic NEN-UP is found, several clues can be obtained from morphological assessment and immunohistochemical staining patterns that individually or in concert may help identify the primary tumor site. Herein, histological and auxiliary analyses of value in this context are discussed in order to aid the pathologist when encountering these lesions in clinical practice.

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Section: The Core-needle Biopsy: Advantages To Fine-needle Aspiration...mentioning

confidence: 99%

Metastatic Neuroendocrine Neoplasms of Unknown Primary: Clues from Pathology Workup

Juhlin

Zedenius

Höög

2022

Cancers

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“…In clinical practice, biopsy sampling with less invasive techniques, such as colonoscopy, are often used for the initial clinical evaluation of CRC . However, an indeterminate diagnosis often creates a dilemma . It has been reported that the miss rate of CRC after colonoscopy, which is the predominant screening and diagnostic test for CRC, is approximately 15% for patients with IBD .…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15] However, an indeterminate diagnosis often creates a dilemma. 16 It has been reported that the miss rate of CRC after colonoscopy, which is the predominant screening and diagnostic test for CRC, 12,17 is approximately 15% for patients with IBD. 12 Moreover, the biopsy location can be inaccurate, which might lead to inaccurately sampled adjacent nontumor tissues and degrading the diagnosis performance.…”

Section: Introductionmentioning

confidence: 99%

A qualitative transcriptional signature for the early diagnosis of colorectal cancer

et al. 2019

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Currently, using biopsy specimens for the early diagnosis of colorectal cancer (CRC) is not entirely reliable due to insufficient sampling amount and inaccurate sampling location. Thus, it is necessary to develop a signature that can accurately identify patients with CRC under these clinical scenarios. Based on the relative expression orderings of genes within individual samples, we developed a qualitative transcriptional signature to discriminate CRC tissues, including CRC adjacent normal tissues from non‐CRC individuals. The signature was validated using multiple microarray and RNA sequencing data from different sources. In the training data, a signature consisting of 7 gene pairs was identified. It was well validated in both biopsy and surgical resection specimens from multiple datasets measured by different platforms. For biopsy specimens, 97.6% of 42 CRC tissues and 94.5% of 163 non‐CRC (normal or inflammatory bowel disease) tissues were correctly classified. For surgically resected specimens, 99.5% of 854 CRC tissues and 96.3% of 81 CRC adjacent normal tissues were correctly identified as CRC. Notably, we additionally measured 33 CRC biopsy specimens by the Affymetrix platform and 13 CRC surgical resection specimens, with different proportions of tumor epithelial cells, ranging from 40% to 100%, by the RNA sequencing platform, and all these samples were correctly identified as CRC. The signature can be used for the early diagnosis of CRC, which is also suitable for minimum biopsy specimens and inaccurately sampled specimens, and thus has potential value for clinical application.

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“…In clinical, biopsy sampling with less-invasive techniques such as colonoscopy and endoscopic ultrasound-guided fine needle aspiration is often used for the initial clinical evaluation of cancer [ 1 – 6 ]. However, an indeterminate diagnosis often creates a dilemma [ 7 ]. Taking colorectal cancer as an example, it has been reported that the miss rate of colorectal cancer after colonoscopy, which is the predominant screening and diagnostic test for colorectal cancer [ 2 , 8 , 9 ], is about 15% for patients with inflammatory bowel diseases (IBD) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Quantitative or qualitative transcriptional diagnostic signatures? A case study for colorectal cancer

et al. 2018

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Background: Due to experimental batch effects, the application of a quantitative transcriptional signature for disease diagnoses commonly requires inter-sample data normalization, which would be hardly applicable under common clinical settings. Many cancers might have qualitative differences with the non-cancer states in the gene expression pattern. Therefore, it is reasonable to explore the power of qualitative diagnostic signatures which are robust against experimental batch effects and other random factors. Results: Firstly, using data of technical replicate samples from the MicroArray Quality Control (MAQC) project, we demonstrated that the low-throughput PCR-based technologies also exist large measurement variations for gene expression even when the samples were measured in the same test site. Then, we demonstrated the critical limitation of low stability for classifiers based on quantitative transcriptional signatures in applications to individual samples through a case study using a support vector machine and a naïve Bayesian classifier to discriminate colorectal cancer tissues from normal tissues. To address this problem, we identified a signature consisting of three gene pairs for discriminating colorectal cancer tissues from non-cancer (normal and inflammatory bowel disease) tissues based on within-sample relative expression orderings (REOs) of these gene pairs. The signature was well verified using 22 independent datasets measured by different microarray and RNA_seq platforms, obviating the need of inter-sample data normalization.

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The dilemma of “indeterminate” interpretations of pancreatic neuroendocrine tumors on fine needle aspiration

Abstract: ICC is commonly employed to confirm the cytologic suspicion for PanNET. The most common reasons for indeterminate diagnoses were a quantitative lack of lesional cells and lack of material for confirmatory ICC.

Cited by 8 publications

References 17 publications

Metastatic Neuroendocrine Neoplasms of Unknown Primary: Clues from Pathology Workup

Metastatic Neuroendocrine Neoplasms of Unknown Primary: Clues from Pathology Workup

A qualitative transcriptional signature for the early diagnosis of colorectal cancer

Quantitative or qualitative transcriptional diagnostic signatures? A case study for colorectal cancer

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