• 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, and Pancreatic Neuroendocrine Disease Alliance (PANDA).
• Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• Ann. Surg. 2023 Jun 1; 277 (6): e1284e1290e1284-e1290.

ObjectivesTo 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.BackgroundWHO 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%.MethodsA 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.ResultsOf 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).ConclusionRecently, 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.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

13 keywords...

hide…