Endoscopy 2020; 52(S 01): S94
DOI: 10.1055/s-0040-1704285
ESGE Days 2020 oral presentations
Friday, April 24, 2020 11:00 – 13:00 Pancreatic solid tumors Liffey Meeting Room 1
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND-FINE NEEDLE ASPIRATION (EUS-FNA) DIAGNOSTIC ACCURACY IN THE EVALUATION OF PANCREATIC NEUROENDOCRINE NEOPLASMS (PNEN) GRADING

M Tacelli
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
MC Petrone
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
G Capurso
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
G Rossi
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
L Archibugi
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
S Testoni
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
,
F Muffatti
2   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreatic Surgery Division, Milan, Italy
,
S Partelli
2   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreatic Surgery Division, Milan, Italy
,
C Doglioni
3   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pathology Department, Milan, Italy
,
M Falconi
2   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreatic Surgery Division, Milan, Italy
,
PG Arcidiacono
1   Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Prognosis of pNENs depends on staging and grading, which is based on the cyto-histological Ki67 labelling. EUS-FNA is considered the gold standard technique to obtain a cytological specimen in pre-therapeutic setting that can be used to evaluate ki67. The aim of this study was to establish the diagnostic accuracy of preoperative EUS-FNA Ki67 evaluation in a cohort of pNEN patients.

Methods This is a retrospective study from a prospectively collected database on patients who underwent surgery for pNENs from 2006 to 2019 and EUS-FNA Ki67 labelling. EUS-FNA and surgery Ki67 (eKi67 and sKi67, respectively) values and grading, were compared and the diagnostic accuracy of EUS-FNA was evaluated with sKi67 as gold standard. eKi67 and sKi67 correlation was evaluated by Pearson’s index.

Results 112 pNEN patients were enrolled. Correlation between eKi67 and sKi67 values was good (coefficient r= 0.78). On EUS-FNA specimens 56/112 (50%) patients were classified as G1, 53 (47.3%) as G2 and 3 (2.7%) as G3, while on surgery they were respectively 59 (52.7%), 50 (44.6%) and 3 (2.7%). In 9.8% grade was increased from G1 to G2 by surgical histology, while in 12.8% it was diminished from G2 to G1. No misclassification occurred in G3 patients. Considering only patients with small tumours (< 2 cm), similar misclassification rate was observed respectively in 9.5% (4/48) and 21.4% (n=9) of cases. Sensitivity, specificity, positive and negative predictive values and accuracy of eKi67 to correctly classify G2 patients were respectively 78.4%, 77.4%, 73.6%, 81.4% and 77.7%. No predictive factors of misclassification were found at multiple regression analysis.

Conclusions This study represents the largest cohort of surgical pNEN patients with preoperative eKi67 evaluation. We found a good correlation between eKi67 and sKi67, but about 20% of patients are not correctly allocated in grading classes. This should be carefully considered especially in small tumours undergoing observation.