Grading Pancreatic Neuroendocrine Tumors via Endoscopic Ultrasound-guided Fine Needle Aspiration: A Multi-Institutional Study

Autor: Ammar A, Javed, Alessandra, Pulvirenti, Samrah, Razi, Jian, Zheng, Theodoros, Michelakos, Yurie, Sekigami, Elizabeth, Thompson, David S, Klimstra, Vikram, Deshpande, Aatur D, Singhi, Matthew J, Weiss, Christopher L, Wolfgang, John L, Cameron, Alice C, Wei, Amer H, Zureikat, Cristina R, Ferrone, Jin, He
Rok vydání: 2023
Předmět:
Zdroj: Annals of surgery.
ISSN: 1528-1140
2015-2019
Popis: 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.WHO grading system is prognostic in pancreatic neuroendocrine tumors (PanNETs). The concordance between c-grade and h-grade is reported to be between 60% and 80%.A multicenter retrospective study was performed on patients undergoing resection for PanNETs at four high-volume centers. 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.Of 1,336 patients included, 682 (51.1%) underwent EUS-FNA; 567 (83.1%) were diagnostic of PanNETs and WHO-grade was reported for 293 (51.7%) patients. The concordance between c-grade and h-grade was 78.2% with moderate inter-rater agreement (Kc=0.48,p0.001). Significantly higher rates of concordance were observed in patients with smaller tumors (2 vs. ≥2 cm, 88.9% vs. 72.7%,p=0.001). Highest concordance (97.9%) was observed in patients with small tumors undergoing assessment between 2015-2019 with near-perfect inter-rater agreement (Kc=0.88,p0.001)An increase in the utilization of EUS-FNA (46.7% to 62.1%) was observed over the last 2 decades (p0.001). EUS-FNA was more frequently diagnostic of PanNETs (p0.001), and WHO-grade was more frequently reported (0.001). However, concordance between c-grade and h-grade did not change significantly (p=0.056).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 PanNETs2 cm in size.
Databáze: OpenAIRE
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