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

Salvatore Paiella; Luca Landoni; Roberta Rota; Matteo Valenti; Giovanni Elio; Stefano Francesco Crinò; Erminia Manfrin; Alice Parisi; Sara Cingarlini; Mirko D’Onofrio; Aldo Scarpa; Rita Teresa Lawlor; Laura Bernardoni; Paola Capelli; Chiara Nessi; Marco Miotto; Armando Gabbrielli; Claudio Bassi; Roberto Salvia

doi:10.1055/a-1180-8614

Endoscopy, Table of Contents

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

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Luca Landoni

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Roberta Rota

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Matteo Valenti

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Giovanni Elio

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Stefano Francesco Crinò

²Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Erminia Manfrin

³Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Alice Parisi

³Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Sara Cingarlini

⁴Oncology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Mirko D’Onofrio

⁵Radiology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Aldo Scarpa

³Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

⁶ARC-Net Applied Research Center, University and Hospital Trust of Verona, Verona, Italy

,

Rita Teresa Lawlor

⁶ARC-Net Applied Research Center, University and Hospital Trust of Verona, Verona, Italy

,

Laura Bernardoni

²Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Paola Capelli

³Department of Diagnostics and Public Health, Section of Pathology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Chiara Nessi

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Marco Miotto

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Armando Gabbrielli

²Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Claudio Bassi

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

,

Roberto Salvia

¹General and Pancreatic Surgery Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

› Author Affiliations

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.

Full Text

References

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