Ki-67 grading of nonfunctioning pancreatic neuroendocrine tumors on histologic samples obtained by EUS-guided fine-needle tissue acquisition: a prospective study.
BACKGROUND
Preoperative determination of Ki-67 expression, an important prognostic factor for grading nonfunctioning pancreatic endocrine tumors (NF-PETs), remains an important clinical challenge.


OBJECTIVE
To prospectively evaluate the feasibility, yield, and clinical impact of EUS-guided fine-needle tissue acquisition (EUS-FNTA) with a large-gauge needle to obtain tissue samples for histologic diagnosis and Ki-67 analysis in patients with suspected NF-PETs.


METHODS
Prospective cohort study.


METHODS
Tertiary-care academic medical center.


METHODS
Consecutive patients with a single pancreatic lesion suspicious for NF-PET on imaging.


METHODS
EUS-FNTA with a 19-gauge needle.


METHODS
Feasibility and yield of EUS-FNTA for diagnosis and Ki-67 expression determination.


RESULTS
Thirty patients (mean [± SD] age 55.7 ± 14.9 years), with a mean (± SD) lesion size of 16.9 ± 6.1 mm were enrolled. EUS-FNTA was successfully performed without complications in all patients, with a mean (± SD) of 2.7 ± 0.5 passes per patient. Adequate samples for histologic examination were obtained in 28 of the 30 patients (93.3%). Ki-67 determination could be performed in 26 of these 28 patients (92.9%, 86.6% overall), 12 of whom underwent surgical resection. Preoperative and postoperative Ki-67 proliferation indexes were concordant in 10 patients (83.3%), whereas 2 patients were upstaged from G1 to G2 or downstaged from G2 to G1, respectively.


CONCLUSIONS
Single center study with a single operator.


CONCLUSIONS
In patients with suspected nonfunctioning low-grade to intermediate-grade pancreatic neuroendocrine tumors (p-NETs), retrieval of tissue specimens with EUS-FNTA by using a 19-gauge needle is safe, feasible, and highly accurate for both diagnosis and Ki-67 determination. A Ki-67 proliferative index acquired through this technique might be of great help for further therapeutic decisions.
Digestive Endoscopy Unit, Divisionof Digestive and Liver Disease, Catholic University, Rome, Italy. albertolarghi@yahoo.it
Alberto
A
Larghi
Gabriele
G
Capurso
Antonella
A
Carnuccio
Riccardo
R
Ricci
Sergio
S
Alfieri
Domenico
D
Galasso
Francesca
F
Lugli
Antonio
A
Bianchi
Francesco
F
Panzuto
Laura
L
De Marinis
Massimo
M
Falconi
Gianfranco
G
Delle Fave
Giovanni Battista
GB
Doglietto
Guido
G
Costamagna
Guido
G
Rindi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies
D019394:Ki-67 Antigen