The role of endoscopic ultrasound-guided Ki67 in the management of non-functioning pancreatic neuroendocrine tumors

Yong Yan 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)213-220
Number of pages8
JournalClinical Endoscopy
Volume53
Issue number2
DOIs
StatePublished - Mar 1 2020

Keywords

  • Concordance
  • Ki67
  • Neuroendocrine
  • Nonfunctioning

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Cui, Y. Y., Khanna, L. G., Saqi, A., Crapanzano, J. P., Mitchell, J. M., Sethi, A., Gonda, T. A., Kluger, M. D., Schrope, B. A., Allendorf, J., Chabot, J. A., & Poneros, J. M. (2020). The role of endoscopic ultrasound-guided Ki67 in the management of non-functioning pancreatic neuroendocrine tumors. Clinical Endoscopy, 53(2), 213-220. https://doi.org/10.5946/ce.2019.068