EUS 引导下细针组织获取的组织样本中 Ki-67 分级在非功能性胰腺神经内分泌肿瘤中的应用：一项前瞻性研究。

Ki-67 grading of nonfunctioning pancreatic neuroendocrine tumors on histologic samples obtained by EUS-guided fine-needle tissue acquisition: a prospective study.

机构信息

Digestive Endoscopy Unit, Divisionof Digestive and Liver Disease, Catholic University, Rome, Italy.

出版信息

Gastrointest Endosc. 2012 Sep;76(3):570-7. doi: 10.1016/j.gie.2012.04.477.

DOI:10.1016/j.gie.2012.04.477

PMID:22898415

Abstract

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.

DESIGN

Prospective cohort study.

SETTING

Tertiary-care academic medical center.

PATIENTS

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

INTERVENTION

EUS-FNTA with a 19-gauge needle.

MAIN OUTCOME MEASUREMENTS

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.

LIMITATIONS

Single center study with a single operator.

CONCLUSION

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.

摘要

背景

Ki-67 表达是评估无功能性胰腺内分泌肿瘤（NF-PETs）分级的重要预后因素，但术前对其进行测定仍是一项临床挑战。

目的

前瞻性评估超声内镜引导下细针组织获取术（EUS-FNTA）联合大口径针获取疑似 NF-PET 患者组织样本进行组织学诊断和 Ki-67 分析的可行性、检出率和临床影响。

设计

前瞻性队列研究。

设置

三级学术医疗中心。

患者

影像学检查提示单个胰腺占位疑似 NF-PET 的连续患者。

干预措施

EUS-FNTA 采用 19 号针。

主要观察指标

EUS-FNTA 进行诊断和 Ki-67 表达测定的可行性和检出率。

结果

共纳入 30 例（平均年龄 55.7 ± 14.9 岁），平均（± SD）病灶大小为 16.9 ± 6.1 mm。所有患者均成功完成 EUS-FNTA，无并发症，平均（± SD）每个患者穿刺 2.7 ± 0.5 次。30 例患者中，28 例（93.3%）获得了足够的组织学检查样本。这 28 例患者中有 26 例（92.9%，总体 86.6%）可进行 Ki-67 检测，其中 12 例行手术切除。10 例（83.3%）患者术前和术后 Ki-67 增殖指数一致，而 2 例患者分别从 G1 期升为 G2 期或从 G2 期降为 G1 期。