The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification

Unno, Jun; Kanno, Atsushi; Masamune, Atsushi; Kasajima, Atsuko; Fujishima, Fumiyoshi; Ishida, Kazuyuki; Hamada, Shin; Kaneda, Kiyoshi; Kikuta, Kazuhiro; Hirota, Morihisa; Motoi, Fuyuhiko; Unno, Michiaki; Shimosegawa, Tooru

doi:10.3109/00365521.2014.934909

Cited by 59 publications

(61 citation statements)

References 46 publications

(57 reference statements)

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“…We could confirm the study by Unno et al [16] which has already elaborated on the importance of tumour size. When using the 5% cut-off, we showed that among the 22 tumours measuring <20 mm, 21 (95.5%) had a concordant grade between cytology and histology.…”

Section: Progression-free Survivalsupporting

confidence: 80%

“…When excluding the FNAs where <200 cells were available for counting, the correlation coefficient was r = 0.574, and when 2,000 cells were counted, the correlation became strong with r = 0.824. These values correspond to those found in the literature where concordance varies between 44 and 89% and the κ coefficient between 0.29 (feeble) and 0.82 (strong) [16,24]. This implies that although we could not define cut-offs between grades, absolute values nicely correlate between Ki67-LI on FNA and resection specimens when counting a maximum of cells on our routine clinical material, confirming the study by Hasegawa et al [15].…”

Section: Progression-free Survivalsupporting

confidence: 79%

“…This is also largely described in the recent literature [2,15,16,[21][22][23][24] and seems to be due to tumour heterogeneity. Yang et al [25], studying tumour heterogeneity on 45 liver metastases from pNETs, showed that G1 tumours are relatively homogeneous, whereas 91% of their G2 cases harboured areas with <3% Ki67-LI.…”

Section: Progression-free Survivalmentioning

confidence: 98%

“…Since 2014 and the publication of our first paper [17], a few groups have done comparative studies between the Ki67-LI obtained on FNA and the corresponding resection specimens [2,9,15,16,[20][21][22][23][24]. Our study represents the largest to date, not only in terms of comparison of grading, but also in terms of Ki67-LI absolute values, between cytology and corresponding resection specimens, studying the influence of tumour size, the number of counted cells on FNA and overall and progression-free survival.…”

Section: Progression-free Survivalmentioning

confidence: 99%

“…Furthermore, in 2014, Hasegawa et al [15] demonstrated the importance of counting >2,000 cells on FNA material to obtain a good correlation with the histological grade in a group of 20 pNETs. On the other hand, tumour size seems also an important factor for a good cytological-histological correlation [16].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Pancreatic Neuroendocrine Tumour Grading by Endoscopic Ultrasound-Guided Fine Needle Aspiration: Analysis of a Large Cohort and Perspectives for Improvement

Boutsen¹,

Jouret‐Mourin²,

Borbath

et al. 2017

Neuroendocrinology

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Introduction: Since the WHO Classification of Tumours of the Digestive System has been published in 2010, resected pancreatic neuroendocrine tumours (pNETs) are graded as grade 1 (G1), grade 2 (G2) or grade 3 (G3) using the Ki67 labelling index (Ki67-LI). Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is often used for diagnosis, but few studies have assessed its value for grading. Aims: The aims of this study were to compare the Ki67-LI obtained by cytological grading (cG) with that obtained by histological grading (hG) and to assess (1) the influence of tumour size and the number of counted cells on FNA grading as well as (2) the overall survival (OS) and progression-free survival based on cG. Materials and Methods: EUS-FNA was performed for 102 pNETs (57 resected). cG (200 cells counted) was done on all FNAs. For 29 FNAs, >2,000 cells were counted (14 resected). A comparison was made between hG and cG for the 57 resected patients. Patients were followed up until June 2016. Results: cG was consistent with hG in 39 of 57 patients with a concordance rate of 72% using a Ki67-LI cut-off of 5% for G1/G2. For Ki67-LI absolute values, the correlation was r = 0.443 and increased to r = 0.824 (p < 0.001) when only FNAs with >2,000 cells were counted. Twenty-one of 22 pNETs <2 cm had the same grading on cG and hG, whereas grading was discordant for 15 of 16 pNETs >2 cm. Thirty-eight patients died after 70.5 months of follow-up. OS for the whole cohort was 235 months and differed between cG1 (235 months), cG2 (36.3 months) and cG3 (10.9 months). Conclusion: cG of pNETs is more accurate when tumours measure <2 cm and more cells are counted on FNA. Discrepancies are seen between G2 tumours which are often considered G1 on FNA due to tumour heterogeneity. EUS-FNA is valuable to distinguish between patients with good (cG1) and poor (cG3) prognosis.

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Section: Progression-free Survivalsupporting

confidence: 80%

Section: Progression-free Survivalsupporting

confidence: 79%

Section: Progression-free Survivalmentioning

confidence: 98%

Section: Progression-free Survivalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of Pancreatic Neuroendocrine Tumour Grading by Endoscopic Ultrasound-Guided Fine Needle Aspiration: Analysis of a Large Cohort and Perspectives for Improvement

Boutsen¹,

Jouret‐Mourin²,

Borbath

et al. 2017

Neuroendocrinology

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Evaluation of Survival Following Surgical Resection for Small Nonfunctional Pancreatic Neuroendocrine Tumors

et al. 2023

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ImportanceThe number of patients with small nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs) is increasing. However, the role of surgery for small NF-PanNETs remains unclear.ObjectiveTo evaluate the association between surgical resection for NF-PanNETs measuring 2 cm or smaller and survival.Design, Setting, and ParticipantsThis cohort study used data from the National Cancer Database and included patients with NF-pancreatic neuroendocrine neoplasms who were diagnosed between January 1, 2004, and December 31, 2017. Patients with small NF-PanNETs were divided into 2 groups: group 1a (tumor size, ≤1 cm) and group 1b (tumor size, 1.1-2.0 cm). Patients without information on tumor size, overall survival, and surgical resection were excluded. Data analysis was performed in June 2022.ExposuresPatients with vs without surgical resection.Main Outcomes and MeasuresThe primary outcome was overall survival of patients in group 1a or group 1b who underwent surgical resection compared with those who did not, which was evaluated using Kaplan-Meier estimates and multivariable Cox proportional hazards regression models. Interactions between preoperative factors and surgical resection were analyzed with a multivariable Cox proportional hazards regression model.ResultsOf the 10 504 patients with localized NF-PanNETs identified, 4641 were analyzed. These patients had a mean (SD) age of 60.5 (12.7) years and included 2338 males (50.4%). The median (IQR) follow-up time was 47.1 (28.2-71.6) months. In total, 1278 patients were in group 1a and 3363 patients were in group 1b. The surgical resection rates were 82.0% in group 1a and 87.0% in group 1b. After adjustment for preoperative factors, surgical resection was associated with longer survival for patients in group 1b (hazard ratio [HR], 0.58; 95% CI, 0.42-0.80; P &lt; .001) but not for patients in group 1a (HR, 0.68; 95% CI, 0.41-1.11; P = .12). In group 1b, interaction analysis found that age of 64 years or younger, absence of comorbidities, treatment at academic institutions, and distal pancreatic tumors were factors associated with increased survival after surgical resection.Conclusions and RelevanceFindings of this study support an association between surgical resection and increased survival in select patients with NF-PanNETs measuring 1.1 to 2.0 cm who were younger than 65 years, had no comorbidities, received treatment at academic institutions, and had tumors of the distal pancreas. Future investigations of surgical resection for small NF-PanNETs that include the Ki-67 index are warranted to validate these findings.

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Clinical Manifestation of Endocrine Tumors of the Pancreas

Kawabe

Ito

2018

The Pancreas

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The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification

Abstract: EUS-FNA with a 22-gauge needle is a safe and highly accurate technique for the diagnosis of pNET. There was a clear correlation between the Ki67LI of histological specimens acquired by EUS-FNA and surgery. EUS-FNA with a 22-gauge needle is useful to predict the WHO classification of pNET.

Cited by 59 publications

References 46 publications

Accuracy of Pancreatic Neuroendocrine Tumour Grading by Endoscopic Ultrasound-Guided Fine Needle Aspiration: Analysis of a Large Cohort and Perspectives for Improvement

Accuracy of Pancreatic Neuroendocrine Tumour Grading by Endoscopic Ultrasound-Guided Fine Needle Aspiration: Analysis of a Large Cohort and Perspectives for Improvement

Evaluation of Survival Following Surgical Resection for Small Nonfunctional Pancreatic Neuroendocrine Tumors

Clinical Manifestation of Endocrine Tumors of the Pancreas

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