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无功能性胰腺神经内分泌肿瘤对超声内镜引导下细针组织获取术所得的组织学标本的Ki-67分级:一项前瞻性

发布日期:2014-1-29 12:40:52 文章来源:ENDOSCOPY 作者次数:1537
    无功能性胰腺神经内分泌肿瘤对超声内镜引导下细针组织获取术所得的组织学标本的Ki-67分级:一项前瞻性研究

    背景
    Ki-67表达是一项重要的无功能性胰腺内分泌肿瘤(NF-PETS)分级的预后因素,它的术前测定仍是一项重要的临床挑战。

    目的

    前瞻性评估采用大号细针行超声内镜引导下细针组织获取(EUS-FNTA)的可行性、获取量和临床影响,旨在获得病理诊断组织样本,并对疑似NF-PETs 患者进行Ki-67 分析。

    设计

    前瞻性队列研究。

    环境

    三级护理学术医疗中心。

    患者

    影像上疑似NF-PET的单胰腺病变患者。

    干预

    采用19号细针行超声内镜引导下细针组织获取术。

    主要测量指标

    超声内镜引导下细针组织获取对诊断和测定Ki-67表达的可行性和获得量。

    结果

    30例患者参与该研究,平均[±SD]年龄为55.7±14.9,平均(± SD)病灶大小为16.9±6.1mm。对所有患者成功进行了超声内镜引导下细针组织获取术,无并发症,每例患者平均穿刺次数(± SD)为2.7±0.5。在30例患者中,从28例患者获得充足的组织学检查样本(93.3%)。在该28例患者中,可对26例进行Ki-67 测定(比例为92.9%;占总体比例为86.6%),其中12例接受了手术切除。10例患者术前与术后Ki-67增殖指数表现一致,即所占比例为83.3%,而2例患者分别从G1 G2 分期升高,或从G2G1 分期下降。

    局限性

    由单一操作者进行的单中心研究。

    结论

    对疑似无功能性低分级至中分级胰腺神经内分泌肿瘤(p-NETs)患者,采用19号细针行超声内镜引导下细针组织获取术来获得组织样本对诊断和Ki-67测定都是安全、可行且具有高度准确性的。经该技术所得的Ki-67 增殖指数可能对进一步的治疗决策有很大帮助。

    缩写词:AJCC,美国癌症联合委员会;ENETS,欧洲神经内分泌肿瘤学会;EUS-FNA,超声内镜引导下细针穿刺术;EUS-FNTA,超声内镜引导下细针组织获取术;NF-PETs,无功能性胰腺内分泌肿瘤;p-NEC,高分级胰腺神经内分泌癌;p-NET,低分级至中分级胰腺神经内分泌肿瘤;TNM,肿瘤、节点、转移;WHO,世界卫生组织


     

    Ki-67 grading of nonfunctioning pancreatic neuroendocrine tumors on histologic samples obtained by EUS-guided fine-needle tissue acquisition: a prospective study

    Received 4 February 2012; accepted 25 April 2012.

    Background

    Preoperative determination of Ki-67 expression, an important prognostic factor for grading nonfunctioning pancreatic endocrine tumors (NF-PETs), remains an important clinical challenge.

    Objective

    To prospectively evaluate the feasibility, yield, and clinical impact of EUS-guided fine-needle tissue acquisition (EUS-FNTA) with a large-gauge needle to obtain tissue samples for histologic diagnosis and Ki-67 analysis in patients with suspected NF-PETs.

    Design

    Prospective cohort study.

    Setting

    Tertiary-care academic medical center.

    Patients

    Consecutive patients with a single pancreatic lesion suspicious for NF-PET on imaging.

    Intervention

    EUS-FNTA with a 19-gauge needle.

    Main Outcome Measurements

    Feasibility and yield of EUS-FNTA for diagnosis and Ki-67 expression determination.

    Results

    Thirty patients (mean [± SD] age 55.7 ± 14.9 years), with a mean (± SD) lesion size of 16.9 ± 6.1 mm were enrolled. EUS-FNTA was successfully performed without complications in all patients, with a mean (± SD) of 2.7 ± 0.5 passes per patient. Adequate samples for histologic examination were obtained in 28 of the 30 patients (93.3%). Ki-67 determination could be performed in 26 of these 28 patients (92.9%, 86.6% overall), 12 of whom underwent surgical resection. Preoperative and postoperative Ki-67 proliferation indexes were concordant in 10 patients (83.3%), whereas 2 patients were upstaged from G1 to G2 or downstaged from G2 to G1, respectively.

    Limitations

    Single center study with a single operator.

    Conclusion

    In patients with suspected nonfunctioning low-grade to intermediate-grade pancreatic neuroendocrine tumors (p-NETs), retrieval of tissue specimens with EUS-FNTA by using a 19-gauge needle is safe, feasible, and highly accurate for both diagnosis and Ki-67 determination. A Ki-67 proliferative index acquired through this technique might be of great help for further therapeutic decisions.

    Abbreviations:  AJCC, American Joint Cancer Committee, ENETS, European Neuroendocrine Tumors Society, EUS-FNA, EUS-guided FNA, EUS-FNTA, EUS-guided fine-needle tissue acquisition, NF-PETs, nonfunctioning pancreatic endocrine tumors, p-NEC, high-grade pancreatic neuroendocrine carcinoma, p-NET, low-grade to intermediate-grade pancreatic neuroendocrine tumor, TNM, tumor, nodes, metastasis, WHO, World Health Organization

     

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