Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading

Abstract

AIM:To evaluate the efficacy of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for grading pancreatic neuroendocrine tumors (PNETs). In the two cases treated with chemotherapy, the effects and prognoses were evaluated. METHODS: RESULTS:The sampling rate for histological diagnosis by EUS-FNA was 100%. No adverse effects were observed. The concordance rate between specimens obtained by EUS-FNA and surgery was 87.5% (7/8). For the two cases treated with chemotherapy, case 1 received somatostatin analog therapy and transcatheter arterial infusion (TAI) targeting multiple liver metastases. Subsequent treatment consisted of everolimus. During chemotherapy, the primary tumor remained unconfirmed, although the multiple liver metastases diminished dramatically. Case 2 was classified as neuroendocrine carcinoma (NEC) according to the Ki-67 index of a specimen obtained by EUS-FNA; therefore, cisplatin and irinotecan therapy was started. However, severe adverse effects, including renal failure and diarrhea, were observed, and the therapy regimen was changed to cisplatin and etoposide. TAI targeting multiple liver metastases was performed. Although the liver metastases diminished, the primary tumor remained unconfirmed. These chemotherapy regimens had immediate effects for both unresectable neuroendocrine tumor (NET) and NEC cases. These two subjects are still alive. Core tip: This is a retrospective study to evaluate the efficacy of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for grading pancreatic neuroendocrine tumors (PNETs). The concordance rate for grading between specimens obtained by EUS-FNA and surgery using the World Health Organization 2010 classification (Ki-67 indexing) was 87.5% in eight evaluated patients. In the two unresectable cases, chemotherapy was performed after grading was established based on the analysis of specimens obtained by EUS-FNA. Both treatments were adequately effective. EUS-FNA was useful for diagnosing PNET and enabled informed decisions on appropriate treatment plans by identifying neuroendocrine tumor or neuroendocrine carcinoma. CONCLUSION: EUS-Sugimoto M, Takagi T, Hikichi T, Suzuki R, Watanabe K, Nakamura J, Kikuchi H, Konno N, Waragai Y, Asama H, Takasumi M, Watanabe H, Obara K, Ohira H. Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading.

Fine‐needle aspiration biopsy of pancreatic neuroendocrine tumors: Correlation between Ki‐67 index in cytological samples and clinical behavior

“…6 Hasegawa et al showed a higher intratumoral dispersion of Ki-67 in grade 2 tumors, and found a concordance rate between EUS-FNA and resected specimens of 74% using the mean Ki-67 index and 77.8% using the highest Ki-67 index. 20 They found discordances only in G1-G2 tumors. 2 McCall et al used digital image analysis software to analyze mitotic rate and Ki-67 index in cytological samples with >500 tumor cells.…”

“…17 Sugimoto et al showed a concordance rate of 87.5%. 20 They found discordances only in G1-G2 tumors. Fujimori et al observed that 89.2% of cases had a Ki-67 index concordant between histology and cytology, and suggested that tumor size and main pancreatic duct obstruction could be helpful in the identification of G2-G3 tumors.…”

“…13 The degree of cell proliferation plays an important role in choosing the correct therapy in patients with unresectable tumors. 20,28 Grading PNETs on EUS-FNA samples can decrease costs and lead to a better management of these patients, avoiding more invasive diagnostic techniques. 10 In addition, new targeted drugs are being studied; the effect of these drugs seems to be influenced by Ki-67 index.…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…Specific ultrasonographic features allow distinction between pancreatic carcinomas and neoplasms of neuroendocrinal origin, as well as between functional and nonfunctional tumours [6,87]. The usefulness of EUS in the assessment of staging has also been confirmed, particularly for the evaluation of vascular invasion and tumour staging [6,88,89].…”

Grading of neuroendocrine tumors

“…Feinnadelpunktaten (FNP) von Pan-NEN eingesetzt werden kann [10,23,59,72]. Bei den G3-Tumoren, welche je nach Lokalisation ca.…”