Grading Pancreatic Neuroendocrine Tumors Via Endoscopic Ultrasound-guided Fine Needle Aspiration: A Multi-institutional Study.

Autor:	Javed AA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Surgery, NYU Grossman School of Medicine, New York, New York., Pulvirenti A; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Razi S; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Zheng J; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Michelakos T; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts., Sekigami Y; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts., Thompson E; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Klimstra DS; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Deshpande V; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Singhi AD; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Weiss MJ; Department of Surgery, Northwell Health, Lake Success, New York., Wolfgang CL; Department of Surgery, NYU Grossman School of Medicine, New York, New York., Cameron JL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Wei AC; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Zureikat AH; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts., He J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Jun 01; Vol. 277 (6), pp. e1284-e1290. Date of Electronic Publication: 2022 Jan 25.
DOI:	10.1097/SLA.0000000000005390
Abstrakt:	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. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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