Proliferative rate in endoscopic ultrasound fine-needle aspiration of pancreatic endocrine tumors: correlation with clinical behavior.
BACKGROUND
The objectives of this study were to evaluate the role of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) in the preoperative diagnosis of pancreatic endocrine tumors (PETs) and to investigate whether the Ki-67 index determined on cytologic material could help predict their behavior.


METHODS
The study included 10 men and 5 women (ratio of men to women, 2:1) with a mean age of 62.4 years (range, 40-79 years). Diff-Quik- and Papanicolaou-stained FNA samples were analyzed retrospectively, and immunocytochemical stains were performed for chromogranin A, synaptophysin, vimentin, alpha-1-antitrypsin, and Ki-67 on cell block sections. The Ki-67 index was evaluated by using digital image-analysis software and was correlated with follow-up (mean, 21.5 months; range, 2-43 months).


RESULTS
The overall survival was rate 86.7% (13 of 15 patients). Seven of 15 patients (46.7%) patients developed lymph node and/or hematogenous metastases. The Ki-67 index in PETs with no metastases was lower (mean, 6.3%; range, 2%-13%) than in clinically aggressive (metastatic) tumors (mean, 7.7%; range, 3%-27%; P = .03). None of the tumors that had a Ki-67 index < or =2% were metastatic. Both patients who died of disease had a Ki-67 index of 4%.


CONCLUSIONS
Although tumors with metastatic potential tended to exhibit a slightly higher Ki-67 index, there was a significant overlap with nonmetastatic tumors, and PETs that had a very low proliferative rate still could behave aggressively; therefore, the authors concluded that the Ki-67 index does not predict the risk of disease progression in patients with PETs.
Department of Pathology, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
Borislav A
BA
Alexiev
Peter E
PE
Darwin
Olga
O
Goloubeva
Olga B
OB
Ioffe
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D049109:Cell Proliferation; D018450:Disease Progression; D004701:Endocrine Gland Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
D019394:Ki-67 Antigen