Qualitative imaging features of pancreatic neuroendocrine neoplasms predict histopathologic characteristics including tumor grade and patient outcome

Yano, Motoyo; Shetty, Anup S.; Williams, Gregory M.; Lancia, Samantha; Trikalinos, Nikolaos A.; Hammill, Chet W.; Hawkins, William G.; Salter, Amber; Chatterjee, Deyali

doi:10.1007/s00261-022-03430-7

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…Unfortunately, most studies investigating vascular/lymphovascular invasion as prognostic factors in resected PanNETs neither specified nor separated venous invasion from small vessel invasion. The results from these studies were not very consistent 19–32. While most studies showed that lymphovascular/vascular invasion were associated with recurrence-free survival only in univariate analysis,23,25,27,28,31,32 a number of other studies demonstrated either significant association with recurrence-free survival in multivariate analysis with a hazard ration ranging from 2.8 to 6.5,19,22,29,30 or no prognostic impact in all analyses 21,26.…”

Section: Discussionmentioning

confidence: 90%

“…The results from these studies were not very consistent 19–32. While most studies showed that lymphovascular/vascular invasion were associated with recurrence-free survival only in univariate analysis,23,25,27,28,31,32 a number of other studies demonstrated either significant association with recurrence-free survival in multivariate analysis with a hazard ration ranging from 2.8 to 6.5,19,22,29,30 or no prognostic impact in all analyses 21,26. The recurrence pattern was reported in some studies, with the liver being the most common site followed by regional lymph nodes 28,29.…”

Section: Discussionmentioning

confidence: 93%

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Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Shi¹,

Chen²,

Davis³

et al. 2023

American Journal of Surgical Pathology

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In this study, we evaluated venous invasion and its association with survival in patients with resected pancreatic neuroendocrine tumor (PanNET). Surgical Pathology Archives were searched for pancreatectomies performed for PanNET between October 1, 2005, and December 31, 2019. Hematoxylin and eosin (H&E)-stained slides were evaluated for venous invasion, and Movat's stain was performed in all cases with no venous invasion detected on H&E stains. Pathology reports and electronic medical records were also reviewed. Venous invasion was identified in 23 of 145 (15.9%) cases on H&E stains, and Movat's stain identified additional 34 cases with venous invasion (39.3% overall). Orphan arteries with adjacent well-defined tumor nodules or subtle hyalinizing nodules in hyalinizing tumors are highly specific for venous invasion. In stage I-III cases (n = 122), venous invasion was associated with larger tumor size, higher World Health Organization (WHO) tumor grade, perineural invasion, extrapancreatic extension, lymph node metastasis, and liver metastasis (P < 0.05). In univariate analyses, tumor size, WHO grade, venous invasion, perineural invasion, T stage, and lymph node metastasis all correlated with disease-free survival; however, only venous invasion was associated with worse disease-free survival in multivariate analyses (P < 0.01). In all-stage cases, venous invasion was the only attributor associated with worse overall survival in multivariate analyses (P = 0.03). In summary, venous invasion in PanNET can be histologically subtle, and Movat's stain can greatly increase the detection rate. More importantly, enhanced venous invasion by Movat's stain correlates independently with disease-free survival in patients with stage I-III tumors and overall survival in allstage patients.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Shi¹,

Chen²,

Davis³

et al. 2023

American Journal of Surgical Pathology

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Neuroendocrine neoplasm imaging: protocols by site of origin

et al. 2022

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Subgrading of G2 Pancreatic Neuroendocrine Tumors as 2A (Ki67 3% to < 10%) Versus 2B (10% to ≤ 20%) Identifies Behaviorally Distinct Subsets in Keeping with the Evolving Management Protocols

Eren,

Bagci,

Balci

et al. 2024

Ann Surg Oncol

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Background Grade 1/2 PanNETs are mostly managed similarly, typically without any adjunct treatment with the belief that their overall metastasis rate is low. In oncology literature, Ki67-index of 10% is increasingly being used as the cutoff in stratifying patients to different protocols, although there are no systematic pathology-based studies supporting this approach. Methods Ki67-index was correlated with clinicopathologic parameters in 190 resected PanNETs. A validation cohort (n = 145) was separately analyzed. Results In initial cohort, maximally selected rank statistics method revealed 12% to be the discriminatory cutoff (close to 10% rule of thumb). G2b cases had liver/distant metastasis rate of almost threefold higher than that of G2a and showed significantly higher frequency of all histopathologic signs of aggressiveness (tumor size, perineural/vascular invasion, infiltrative growth pattern, lymph node metastasis). In validation cohort, these figures were as striking. When all cases were analyzed together, compared with G1, the G2b category had nine times higher liver/distant metastasis rate (6.1 vs. 58.5%; p < 0.001) and three times higher lymph node metastasis rate (20.5 vs. 65.1%; p < 0.001). Conclusions G2b PanNETs act very similar to G3, supporting management protocols that regard them as potential therapy candidates. Concerning local management, metastatic behavior in G2b cases indicate they may not be as amenable for conservative approaches, such as watchful waiting or enucleation. This substaging should be considered into diagnostic guidelines, and clinical trials need to be devised to determine the more appropriate management protocols for G2b (10% to ≤ 20%) group, which shows liver/distant metastasis in more than half of the cases, which at minimum warrants closer follow-up.

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Qualitative imaging features of pancreatic neuroendocrine neoplasms predict histopathologic characteristics including tumor grade and patient outcome

Cited by 4 publications

References 31 publications

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Neuroendocrine neoplasm imaging: protocols by site of origin

Subgrading of G2 Pancreatic Neuroendocrine Tumors as 2A (Ki67 3% to < 10%) Versus 2B (10% to ≤ 20%) Identifies Behaviorally Distinct Subsets in Keeping with the Evolving Management Protocols

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