Clin Endosc.  2020 Mar;53(2):213-220. 10.5946/ce.2019.068.

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

• Cui Y
• Khanna LG
• Saqi A
• Crapanzano JP
• Mitchell J
• Sethi A
• Gonda TA
• Kluger MD
• Schrope BA
• Allendorf
• Chabot JA
• Poneros JM

• KMID: 2500889
• DOI: http://doi.org/10.5946/ce.2019.068

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 NFPNETs 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 NFPNETs 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 EUSFNA can be monitored without surgical intervention, up to tumor size 20 mm.

Keyword

Nonfunctioning; Neuroendocrine; Concordance; Ki67

Figure

• 

  Fig. 1. Time to disease recurrence for low- and intermediate-grade versus high-grade nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs), based on surgical pathology Ki67 of 35 NF-PNET cases.Green line = NF-PNETs with high-grade Ki67, Blue line = NF-PNETs with low- and intermediate-grade Ki67.

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