Grading pancreatic neuroendocrine tumors via endoscopic ultrasound-guided fine needle aspiration: A multi-institutional study Journal Article
| Authors: | Javed, A. A.; Pulvirenti, A.; Razi, S.; Zheng, J.; Michelakos, T.; Sekigami, Y.; Thompson, E.; Klimstra, D. S.; Deshpande, V.; Singhi, A. D.; Weiss, M. J.; Wolfgang, C. L.; Cameron, J. L.; Wei, A. C.; Zureikat, A. H.; Ferrone, C. R.; He, J.; and Pancreatic Neuroendocrine Disease Alliance (PANDA) |
| Article Title: | Grading pancreatic neuroendocrine tumors via endoscopic ultrasound-guided fine needle aspiration: A multi-institutional study |
| Abstract: | Objectives:To identify factors associated with concordance between World Health Organization (WHO) grade on cytological analysis (c-grade) and histopathological analysis (h-grade) of surgical specimen in patients with PanNETs and examine trends in utilization and accuracy of EUS-FNA in preoperatively predicting grade. Background:WHO grading system is prognostic in pancreatic neuroendo-crine tumors (PanNETs). The concordance between c-grade and h-grade is reported to be between 50% and 92%. Methods:A multicenter retrospective study was performed on patients undergoing resection for PanNETs at four high-volume centers between 2010 and 2019. Patients with functional or syndrome-associated tumors, and those receiving neoadjuvant therapy were excluded. Factors associated with concordance between c-grade and h-grade and trends of utilization of EUS-FNA were assessed. Results:Of 869 patients included, 517 (59.5%) underwent EUS-FNA; 452 (87.4%) were diagnostic of PanNETs and WHO-grade was reported for 270 (59.7%) patients. The concordance between c-grade and h-grade was 80.4% with moderate concordance (Kc = 0.52, 95% CI: 0.41-0.63). Significantly higher rates of concordance were observed in patients with smaller tumors (<2 vs. >= 2cm, 81.1% vs. 60.4%, P = 0.005). Highest concordance (98.1%) was observed in patients with small tumors undergoing assessment between 2015-2019 with a near-perfect concordance (Kc = 0.88, 95% CI: 0.61-1.00). An increase in the utilization of EUS-FNA (56.1% to 64.1%) was observed over the last 2 decades (P = 0.017) and WHO-grade was more frequently reported (44.2% vs. 77.6%, P < 0.001). However, concordance between c-grade and h-grade did not change significantly (P = 0.118). Conclusion:Recently, a trend towards increasing utilization and improved diagnostic accuracy of EUS-FNA has been observed in PanNETs. Concordance between c-grade and h-grade is associated with tumor size with near-perfect agreement when assessing PanNETs <2cm in size. |
| Keywords: | pancreatic neoplasms; classification; biopsy; diagnosis; malignancy; management; surveillance; lesions; specimens; nodal disease; pancreatic neuroendocrine tumors; predictive model; consensus guidelines; ki-67 index; small tumors; pannets |
| Journal Title: | Annals of Surgery |
| Volume: | 277 |
| Issue: | 6 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-06-01 |
| Start Page: | e1284 |
| End Page: | e1290 |
| Language: | English |
| ACCESSION: | WOS:000992555200037 |
| DOI: | 10.1097/sla.0000000000005390 |
| PROVIDER: | wos |
| PMCID: | PMC9364076 |
| PUBMED: | 35081574 |
| Notes: | Article -- Source: Wos |
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