title: Cytology assessment can predict survival for patients with metastatic pancreatic neuroendocrine neoplasms.
abstract: BACKGROUND
  Histological features and Ki-67 index have known usefulness in predicting prognosis and guiding therapy among patients with metastatic pancreatic neuroendocrine neoplasms. Fine-needle aspiration may offer advantages for Ki-67 assessment because the technique obtains highly cellular, well-preserved specimens with the potential for broader tumor sampling. In the current study, the authors evaluated concordance for grade and differentiation between concurrent core needle biopsy and cytology preparations. Cytological features and grade then were correlated with survival.
  
  
  METHODS
  Differentiation, grade by Ki-67 index, and correlation of these features with survival were compared between concurrent core needle biopsy and cytology specimens from 44 patients with metastatic pancreatic neuroendocrine neoplasms.
  
  
  RESULTS
  Differentiation by cytology smear resulted in 38 cases of well (86%) and 6 cases of poor (14%) differentiation. Agreement for differentiation between smear and cell block, smear and core needle biopsy, and cell block and core needle biopsy was 88%, 94%, and 83%, respectively, and agreement for grade was 68%, 54%, and 22%, respectively. Cytology differentiation and cytology grade were found to be strong predictors of outcome with respective hazard ratios of 8.3 (95% confidence interval [95% CI], 3.1-22.1; P<.001) and 1.9 (95% CI, 1.2-2.9) for each ascending grade. The median disease-specific survival cytology projections were 121 months (95% CI, 57-185 months [estimated]) for grade 1, 45 months (95% CI, 29-87 months) for grade 2, and 19 months (95% CI, 1-44 months) for grade 3, with median survivals of 45 months and 3 months, respectively, for patients with well-differentiated and poorly differentiated neuroendocrine tumors (P<.001).
  
  
  CONCLUSIONS
  Grading of pancreatic neuroendocrine neoplasms on cytology may not correlate exactly with concurrent core needle biopsy, but cytology differentiation and grade are predictive of survival based on stage-adjusted analysis. Cancer Cytopathol 2017;125:188-196. © 2016 American Cancer Society.
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Carlie S
authors.initials: CS
authors.lastname: Sigel
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Huimin
authors.initials: H
authors.lastname: Guo
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Sigel
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rekhtman
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Oscar
authors.initials: O
authors.lastname: Lin
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: David S
authors.initials: DS
authors.lastname: Klimstra
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Achim A
authors.initials: AA
authors.lastname: Jungbluth
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D001707:Biopsy, Needle; D002454:Cell Differentiation; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis
chemical_list: D019394:Ki-67 Antigen
keywords: Ki-67 index; cytology; differentiation; grade; metastatic; neuroendocrine carcinoma; pancreas; pancreatic neuroendocrine tumor