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  1. Download Surgical Pathology of Endocrine and Neuroendocrine Tumors (Current Clinical Pathology)
  2. Current treatment status in pancreatic neuroendocrine neoplasms - Liu - Chinese Clinical Oncology
  3. Bibliographic Information
  4. Surgical Pathology of Endocrine and Neuroendocrine Tumors (Current Clinical Pathology)

Download Surgical Pathology of Endocrine and Neuroendocrine Tumors (Current Clinical Pathology)

Gut ; J Gastrointest Surg ; Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography. Fein J, Gerdes H. Localization of islet cell tumors by endoscopic ultrasonography. Pathology and Genetics of Tumours of the Digestive System. Prognostic factors and survival in patients with pancreatic endocrine tumor treated at a single institution.

Clin Cancer Res ; Mod Pathol ; TNM staging of neoplasms of the endocrine pancreas: Results from a large international cohort study. J Natl Cancer Inst ; Surgery for midgut carcinoid. Endocr Relat Cancer ; Nonfunctioning islet cell tumors. Islet cell carcinomas of the pancreas: A twenty-year experience. Surgery ; Analysis of 6, pancreatic neuroendocrine tumors for a proposed staging system.

Tumor-associated macrophages are a useful biomarker to predict recurrence after surgical resection of nonfunctional pancreatic neuroendocrine tumors. This article has been cited by 1 Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine-needle aspiration cytology Abby M.

Current treatment status in pancreatic neuroendocrine neoplasms - Liu - Chinese Clinical Oncology

Richmond,Sanjana Mehrotra Diagnostic Cytopathology. Users Online Home. Risk factors for aggressive nonfunctional pancreatic neuroendocrine tumors and the role of endoscopic ultrasound guided fine-needle aspiration. Endosc Ultrasound ; Figure 1: Tumor size in patients with no metastases is compared to tumors size in patients with metastases liver or lymph node. Quartiles are indicated by the box with the median being the line in the box and the mean being the symbols within the box. Figure 2: Tumor size in patients with no metastases is compared to tumor size in patients with metastases to liver only.


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Quartiles are indicated by the box with the median being the line in the box and the mean being the symbols in the box. Table 2: Comparison of patients with and without metastases to liver or lymph nodes Click here to view. Table 3. Comparison of patients with and without liver metastases Click here to view. Figure 3: ROC curve analysis to determine the sensitivity and specificity of using various tumor size cutoff points above which patients should undergo further evaluation for metastatic disease Click here to view.

This article has been cited by. Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine-needle aspiration cytology. Pancreatic neuroendocrine tumors: the basics, the gray zone, and the target. Fine-needle aspiration biopsy of pancreatic neuroendocrine tumors: Correlation between Ki index in cytological samples and clinical behavior. Diagnostic value of chromogranin A in pancreatic neuroendocrine tumors depends on tumor size: A prospective observational study from a single institute.

The diagnostic value of FNA biopsy in grading pancreatic neuroendocrine tumors. Access Statistics. Materials and me Article Figures. Article Tables. In addition to tumor size, histologic features such as necrosis, lymphovascular invasion, mitotic count, Ki index, and immunohistochemical expression of cytokeratin 19 have been used as prognostic indicators.

Instead of using a single hybrid grade- and stage-based system, the new WHO classification recommends a purely grade-based classification system and a separate site-specific TNM staging system. The proliferative index has emerged as a significant prognostic indicator and directly determines the tumor grade for PanNETs, especially in patients with same-stage tumors. Various digital image analysis platforms have been shown in previous studies to be an effective method for scoring immunohistochemical results, including the Ki index.

We set out in this pilot study to do the following: 1 compare MI with Ki index results obtained by 2 digital imaging methods, a single HS field count, and a random 10 consecutive field count; 2 assess the implications on tumor grading; and 3 determine which method may better predict metastatic disease. This study was designed as a pilot study to assess potential variability in assessing proliferative indexes when different methods are used. High-grade neuroendocrine carcinomas were not included in this study.

This project is the result of a quality improvement initiative approved by the institutional Total Quality Council. A total of 45 PanNETs were evaluated from 22 men and 22 women with an average age of All of the tumors were graded according to the WHO classification. Mitotic figures were counted for 50 HPF 0. Ki immunohistochemical slides, available from the initial diagnostic workup or performed on suitable tissue blocks, were used for our analysis. Ki—immunostained slides were imaged using the Ventana image analysis system VIAS; Ventana Medical Systems , a computer-assisted system that captures a slide area of The user confirmed that all positive cells selected by the computer were tumor cells and that nontumor cells eg, endothelial cells, lymphocytes were excluded from analysis.

A Ki HS count in the area of highest positive nuclei concentration and a random 10 consecutive field average CFA were obtained for each case. Examples of low- and intermediate-grade tumors are shown in Image 1. The clinicopathologic data for these 3 groups are summarized in Table 3. By HS counting, an average of nuclei were counted, with 21 cases having fewer than nuclei and 24 cases having more than nuclei. For CFA, an average of nuclei per field range, 84— and an average total of 1, nuclei range, —3, were counted.

In group 1, the HS analysis yielded fewer than counted nuclei in 4 cases and more than counted nuclei in 9 cases average nuclei, ; range, — ; the CFA yielded an average nuclei count of 1, range, 1,—2, In group 2, HS yielded fewer than counted nuclei in 11 cases and more than counted nuclei in 15 cases average nuclei, ; range, 86— ; the CFA yielded an average nuclei count of 2, range, —3, In group 3, HS yielded fewer than counted nuclei in all 6 cases average nuclei, ; range, — ; the CFA yielded an average nuclei count of 1, range, —1, Well-differentiated pancreatic neuroendocrine tumors.

All 13 cases in group 1 were classified as low grade by HS and MI. Because metastatic disease is a well-documented predictor of prognosis in PanNETs, 4 , 8 , 11 we used this as an indicator of more aggressive behavior in our cases. Based on the ROC analysis, using a higher cutoff for Ki of more than 7.

In HS analysis with a cutoff value for Ki of more than 7. However, the practical act of generating these values has been varied, with some methods seeming impractical for routine clinical purpose such as counting 2, cells as proposed by ENETS. Because this distinction has potential implications for follow-up interval and receipt of additional therapy, it is important to accurately and reproducibly determine the Ki index. A recent consensus report by Klimstra et al, 23 which involved a diverse panel of 12 pathologists and 8 clinicians, noted disagreement among participants on the optimal method of Ki index determination of PanNETs.

Neuroendocrine tumours (NETs): symptoms, diagnosis and treatment

While use of digital imaging to calculate Ki proliferative indexes in neuroendocrine tumors is still not widely practiced, computer-assisted counting has been shown to be a viable alternative to pathologist counting in a manner that is practical and time-effective. One source of inconsistency may be the total number of cells counted. When compared with these HS counts, the CFA counts which counted an average of 1, cells demonstrated an overall reduction in proliferative index. These are reasonable observations, since the proliferative index is often variable within a tumor, with the highest index most commonly located at the leading edge of the tumor.

If clinical decisions, such as to treat or not to treat with chemotherapy or to alter follow-up surveillance intervals, rely on the grade of the PanNET low vs intermediate grade , the specificity and the PPV of the test used to decide this difference should be optimized. Our data suggest that when using HS analysis, a cutoff value for Ki of 7.


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  • This study was designed as a preliminary assessment of the variability that can arise when different methods for determining the proliferative index are used. We provided evidence that enough variability exists to warrant additional studies that use larger populations of patients with PanNETs with long-term outcome data. Even though our study population is small, the findings shed light on the difficulty of determining which method to use to detect proliferation rates in PanNETs and of determining the significance of the result.

    Moreover, the study raises serious concerns about our ability to accurately discriminate between low- and intermediate-grade well-differentiated PanNETs. Until better prognostic indicators are developed for PanNETs, Ki proliferative indexes will be used. Although digital imaging can be used to calculate Ki proliferative indexes and will likely provide a more practical and time-effective assessment in the near future, our results demonstrate that the counting method can significantly impact the score and that different cutoff values will most likely be required for each method.

    This study also suggests, however, that if a higher Ki cutoff for intermediate-grade tumors is used when applying the HS method, HS analysis of a single cell field provides a similar or an increased PPV for predicting aggressive tumor behavior metastasis when compared with other methods, without the need to count 2, cells or manually count mitotic figures. We recommend that individual practices adopt a uniform method to measure the Ki proliferative index. If single-field HS analysis is used, the results need to be interpreted with caution.

    Pathologists should consider specifying their scoring method in the pathology report because the method clearly impacts the score for a given tumor.

    Bibliographic Information

    Physicians should claim only the credit commensurate with the extent of their participation in the activity. The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. Questions appear on p Exam is located at www.

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