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Reliability of Ki-67 Determination in FNA Samples for Grading Pancreatic Neuroendocrine Tumors

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Abstract

Neuroendocrine pancreatic tumors (PanNETs) are graded on the basis of their proliferative activity. Cytological samples are commonly the only samples available, but the determination of Ki-67 in cytology and its reliability as a measure of tumor mitotic activity is not well settled. We have retrospectively reviewed all the cases of FNA under EUS control of PanNETs in a 10-year period (2006–2016) in the Hospital Clínico San Carlos (Madrid). We identified 10 PanNET cases with histological correlation. Median age was 49.4 years and the patients were mainly women. PanNETs were located more frequently in the tail of the pancreas, with a median size of 33.8 mm. None of our cases was a grade 3 tumor. The seven grade 1 tumors confirmed in histology had consistent Ki-67 in cytology. In three cases (30 %), there were discrepancies between the Ki-67 index measured in cytology and histology, and the differences ranged from 2 to 15 %; all these cases were grade 2 tumors in histology and were graded as grade 1 tumors in FNA material. Our results are consistent with previous studies which showed understaging when tumor grade was assessed in cytological samples, mainly in G2 tumors. Previous literature has shown that Ki-67 assessment in EUS-FNA samples is a useful tool to rule out G3 tumors, but can be problematic for distinguishing G1 and G2 tumors.

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Acknowledgments

Special thanks are due to J. Miguel Esteban López-Jamar, Department of Gastroenterology, Hospital Clínico San Carlos, Madrid.

Authors’ Contribution

Cristina Díaz del Arco was responsible for the study conception and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript; J. Ángel Díaz Pérez for the acquisition of data, drafting of the manuscript, and critical revision; Luis Ortega Medina for study conception and design, analysis and interpretation of data, and critical revision; Javier Sastre Valera for the acquisition of data, analysis and interpretation of data, and critical revision; and M. Jesús Fernández Aceñero for the study conception and design, analysis and interpretation of data, and critical revision.

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Authors and Affiliations

  1. Department of Surgical Pathology, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain

    Cristina Díaz del Arco, Luis Ortega Medina & M. Jesús Fernández Aceñero

  2. Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain

    J. Ángel Díaz Pérez

  3. Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain

    Javier Sastre Valera

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  1. Cristina Díaz del Arco
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Correspondence to Cristina Díaz del Arco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Retrospective study: For this type of study, formal consent is not required.

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Díaz del Arco, C., Díaz Pérez, J.Á., Ortega Medina, L. et al. Reliability of Ki-67 Determination in FNA Samples for Grading Pancreatic Neuroendocrine Tumors. Endocr Pathol 27, 276–283 (2016). https://doi.org/10.1007/s12022-016-9455-2

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