Park Ji Hyun, Shin Su-Jin, Jeon Nara, Lim Beom Jin
Department of Pathology, Yonsei University College of Medicine Seoul, Republic of Korea.
Int J Clin Exp Pathol. 2023 Sep 15;16(9):225-234. eCollection 2023.
Neuroendocrine tumors (NETs) are a heterogeneous group of tumors that arise at various sites throughout the body. The gastroenteropancreatic (GEP) tract is the most common site of NETs. We investigated the clinicopathologic features of patients with GEP-NETs and the utility of digital image analysis, which was compared to eyeball estimation, a conventional method used to determine the Ki-67 labeling index.
The clinicopathologic data of GEP-NET patients at Gangnam Severance Hospital from January 2008 to October 2019 were retrospectively analyzed. Each case was reclassified according to the 2019 World Health Organization classification system, to which the classification of grade 3 was added. Comparisons between eyeball estimation and the digital image analysis method for Ki-67 index assessment were performed by calculating Cohen's kappa (k) coefficient.
In total, 345 patients with GEP-NETs were enrolled. The mean age was 49.3 (range 13-79) years, with more male (61.1%) than female patients. The primary tumor sites were the rectum (70.1%), pancreas (12.5%), stomach (6.7%), and duodenum (5.8%). Overall, 298 (86.4%), 35 (10.1%), 2 (0.6%), and 10 (2.9%) patients exhibited grade 1, 2, and 3 and neuroendocrine carcinoma, respectively. Statistical analysis revealed that age > 50 years, tumor size > 2 cm, and presence of lymphovascular invasion, nodal metastasis, and distant metastasis were significantly associated with short overall survival. Additionally, 283 patients underwent digital image analysis of the Ki-67 index, and substantial agreement was found between the two methods (κ value: 0.765).
Eyeball estimation revealed non-inferior results compared with digital image analysis. Further research is needed to evaluate the possibility of using digital image analysis as an alternative analysis method.
神经内分泌肿瘤（NETs）是一组异质性肿瘤，可发生于全身各处。胃肠胰（GEP）道是NETs最常见的发生部位。我们研究了GEP-NETs患者的临床病理特征以及数字图像分析的实用性，并将其与用于确定Ki-67标记指数的传统方法——肉眼估计进行比较。
回顾性分析2008年1月至2019年10月江南Severance医院GEP-NET患者的临床病理资料。根据2019年世界卫生组织分类系统对每个病例进行重新分类，并增加了3级分类。通过计算科恩kappa（κ）系数，对Ki-67指数评估的肉眼估计法和数字图像分析法进行比较。
共纳入345例GEP-NETs患者。平均年龄为49.3岁（范围13 - 79岁），男性患者（61.1%）多于女性患者。原发肿瘤部位为直肠（70.1%）、胰腺（12.5%）、胃（6.7%）和十二指肠（5.8%）。总体而言，分别有298例（86.4%）、35例（10.1%）、2例（0.6%）和10例（2.9%）患者表现为1级、2级、3级和神经内分泌癌。统计分析显示，年龄>50岁、肿瘤大小>2 cm以及存在脉管侵犯、淋巴结转移和远处转移与总生存期短显著相关。此外，283例患者接受了Ki-67指数的数字图像分析，两种方法之间存在高度一致性（κ值：0.765）。
与数字图像分析相比，肉眼估计显示出非劣效结果。需要进一步研究以评估将数字图像分析用作替代分析方法的可能性。
