General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Endoscopy. 2020 Nov;52(11):988-994. doi: 10.1055/a-1180-8614. Epub 2020 Jun 4.
Data on the reliability of the Ki-67 index and grading calculations from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic neuroendocrine tumors (PanNETs) are controversial. We aimed to assess the accuracy of these data compared with histology.
Cytological analysis from EUS-FNA in patients with suspected PanNETs (n = 110) were compared with resection samples at a single institution. A minimum of 2000 cells were considered to be adequate for grading. Correlation and agreement between cytology and histology in grading and Ki-67 values, respectively, were investigated. Secondary outcomes included the diagnostic performance of EUS-FNA.
EUS-FNA samples were adequate for PanNET diagnosis and PanNET grading in 98/110 (89.1 %) and 77/110 (70.0 %) patients, respectively; thus, 77 samples were adequate for comparing cytology vs. histology. There were 67 (62.0 %), 40 (36.4 %), and 1 (0.9 %) patients with a final diagnosis of G1, G2, and G3 tumors, respectively. EUS-FNA grading was concordant with surgical pathology in 81.8 % of patients; under- and overgrading occurred in 15.6 % and 2.6 %, respectively. The overall level of agreement for grading was moderate (Cohen's κ = 0.59, 95 % confidence interval [CI] 0.34 - 0.78). Spearman's rho for Ki-67 in tumors ≤ 20 mm and > 20 mm was strong and moderate, respectively (rho = 0.68, 95 %CI 0.47 - 0.83; rho = 0.59, 95 %CI 0.35 - 0.75). The Bland - Altman plot showed that the Ki-67 values were comparable and reproducible between the two measurements.
Although they were not available for a significant number of patients, grading and Ki-67 values from cytology correlated with histology moderately to strongly.
内镜超声引导下细针抽吸术（EUS-FNA）获取的胰腺神经内分泌肿瘤（PanNET）的 Ki-67 指数和分级计算的数据可靠性存在争议。我们旨在评估这些数据与组织学相比的准确性。
在一家机构中，将 EUS-FNA 对疑似 PanNET 患者（n=110）的细胞学分析与切除样本进行比较。至少 2000 个细胞被认为足以进行分级。分别研究了细胞学和组织学在分级和 Ki-67 值方面的相关性和一致性。次要结局包括 EUS-FNA 的诊断性能。
EUS-FNA 样本足以对 110 例患者中的 98/110（89.1%）例进行 PanNET 诊断和 PanNET 分级，分别为 77/110（70.0%）例；因此，77 个样本可用于比较细胞学与组织学。最终诊断为 G1、G2 和 G3 肿瘤的患者分别为 67（62.0%）例、40（36.4%）例和 1（0.9%）例。EUS-FNA 分级与手术病理学在 81.8%的患者中一致；低估和高估分级分别发生在 15.6%和 2.6%的患者中。分级的总体一致性水平为中度（Cohen's κ=0.59，95%置信区间 [CI] 0.34-0.78）。肿瘤直径≤20mm 和＞20mm 的 Ki-67 值的 Spearman's rho 分别为强相关和中度相关（rho=0.68，95%CI 0.47-0.83；rho=0.59，95%CI 0.35-0.75）。Bland-Altman 图显示，两种测量方法的 Ki-67 值具有可比性和可重复性。
尽管细胞学分级和 Ki-67 值的结果在很大程度上与组织学相关，但由于样本数量不足，它们与组织学的相关性为中度至强。
