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Endoscopy 2020; 52(11): 988-994
DOI: 10.1055/a-1180-8614
Original article

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis and grading of pancreatic neuroendocrine tumors: a retrospective analysis of 110 cases

Salvatore Paiella
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Luca Landoni
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Roberta Rota
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Matteo Valenti
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Giovanni Elio
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Stefano Francesco Crinò
2   Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Erminia Manfrin
3   Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Alice Parisi
3   Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Sara Cingarlini
4   Oncology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Mirko D’Onofrio
5   Radiology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Aldo Scarpa
3   Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
6   ARC-Net Applied Research Center, University and Hospital Trust of Verona, Verona, Italy
,
Rita Teresa Lawlor
6   ARC-Net Applied Research Center, University and Hospital Trust of Verona, Verona, Italy
,
Laura Bernardoni
2   Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Paola Capelli
3   Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Chiara Nessi
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Marco Miotto
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Armando Gabbrielli
2   Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Claudio Bassi
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
,
Roberto Salvia
1   General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
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Author commentary on Salvatore Paiella et al.Endoscopy 2020; 52(11): v40-v40
DOI: 10.1055/a-1169-8838

Abstract

Background 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.

Methods 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.

Results 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.

Conclusions Although they were not available for a significant number of patients, grading and Ki-67 values from cytology correlated with histology moderately to strongly.



Publication History

Received: 12 October 2019

Accepted: 29 April 2020

Article published online:
04 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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