Virchows Archiv

, Volume 462, Issue 5, pp 501–505 | Cite as

Ki-67 is a reliable pathological grading marker for neuroendocrine tumors

  • Ashlie Nadler
  • Moises Cukier
  • Corwyn Rowsell
  • Sepideh Kamali
  • Yael Feinberg
  • Simron Singh
  • Calvin H. L. Law
Original Article


In neuroendocrine tumors (NETs), proliferation markers, especially Ki-67, have become increasingly important. This study was designed to examine the reproducibility of Ki-67 for use in the current classification of NETs. A retrospectively assembled integrated database with prospectively collected data of patients undergoing multidisciplinary management for NETs from 2000 to 2009 was analyzed. Original pathology was reviewed to reassess Ki-67 values. Ki-67 was then categorized to grades G1 (≤2 %), G2 (3–20 %), or G3 (>20 %) according to the European Neuroendocrine Tumor Society (ENETS) guidelines and the 2010 World Health Organization (WHO) classification. Original Ki-67 values were compared to reviewed values. All statistical analyses were carried out using SAS 9.1.3. A total of 184 patients were included of which 48 % were male. The most common primary NET site was the small bowel, in 27 %. On pathology review, there was 94 % agreement for G1, with 4 % of cases upgraded at review to G2 and 2 % of cases upgraded to G3. For G2, there was 94 % agreement, with 6 % of cases downgraded to G1 and 0 % upgraded. For G3, there was 90 % agreement, with 10 % of cases downgraded to G2 and none to G1 (kappa = 0.89). Ki-67 is a proliferative marker for NETs that is highly reproducible when used to grade tumors according to ENETS and WHO categories. The high inter-institutional reliability in the determination of tumor grade as assessed by Ki-67 makes it a reliable tool in the assessment of patients with NETs.


Neuroendocrine tumor Carcinoid Ki-67 Reliability 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ashlie Nadler
    • 1
  • Moises Cukier
    • 2
  • Corwyn Rowsell
    • 3
  • Sepideh Kamali
    • 4
  • Yael Feinberg
    • 5
  • Simron Singh
    • 6
  • Calvin H. L. Law
    • 2
  1. 1.Division of General SurgeryUniversity of TorontoTorontoCanada
  2. 2.Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  3. 3.Department of Anatomic Pathology, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  4. 4.Sunnybrook Health Sciences CentreTorontoCanada
  5. 5.University of TorontoTorontoCanada
  6. 6.Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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