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Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours?

Publication ,  Journal Article
Numbere, N; Huber, AR; Shi, C; Cates, JMM; Gonzalez, RS
Published in: Histopathology
February 2019

AIMS: Well-differentiated small intestinal neuroendocrine tumours (SI-NETs) are often multifocal, and this has been suggested to impart worse disease-free survival. Practice guidelines have not been established for World Health Organisation (WHO) grading of multiple primary lesions. METHODS AND RESULTS: We identified 68 patients with ileal/jejunal SI-NET for a combined total of 207 primary lesions. Each case was evaluated for patient age and sex; size of all tumours; presence of lymph node metastases, mesenteric tumour deposits or distant metastases; and disease-specific outcome. Ki67 staining was performed on all 207 primary lesions. The relationship between multifocality and clinicopathological factors was compared using Fisher's exact test. Outcome was tested using Cox proportional hazard regression. Forty-two patients had unifocal disease, and 26 had multifocal disease (median five lesions, range = 2-32). Most tumours were WHO grade 1 (201 of 207, 97%). Of the five patients with grades 2/3 tumours, three patients had unifocal disease, one patient had two subcentimetre grade 2 lesions (including the largest) and eight subcentimetre grade 1 lesions, and one patient had one 1.6-cm grade 3 lesion and one subcentimetre grade 1 lesion. There was a positive correlation between tumour size and Ki67 index (coefficient 0.28; 95% confidence interval 0.05-0.52, P = 0.017). There was no significant association between multifocality and nodal metastases, mesenteric tumour deposits, distant metastases or disease-specific survival. CONCLUSIONS: In patients with multifocal SI-NET, unless a particular lesion has a high mitotic rate, only staining the largest lesion for Ki67 should serve to grade almost all cases accurately. Multifocality does not appear to significantly impact patient survival.

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Published In

Histopathology

DOI

EISSN

1365-2559

Publication Date

February 2019

Volume

74

Issue

3

Start / End Page

424 / 429

Location

England

Related Subject Headings

  • Proportional Hazards Models
  • Pathology
  • Neuroendocrine Tumors
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Ki-67 Antigen
  • Intestine, Small
  • Intestinal Neoplasms
  • Immunohistochemistry
 

Citation

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Numbere, N., Huber, A. R., Shi, C., Cates, J. M. M., & Gonzalez, R. S. (2019). Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours? Histopathology, 74(3), 424–429. https://doi.org/10.1111/his.13771
Numbere, Numbereye, Aaron R. Huber, Chanjuan Shi, Justin M. M. Cates, and Raul S. Gonzalez. “Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours?Histopathology 74, no. 3 (February 2019): 424–29. https://doi.org/10.1111/his.13771.
Numbere N, Huber AR, Shi C, Cates JMM, Gonzalez RS. Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours? Histopathology. 2019 Feb;74(3):424–9.
Numbere, Numbereye, et al. “Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours?Histopathology, vol. 74, no. 3, Feb. 2019, pp. 424–29. Pubmed, doi:10.1111/his.13771.
Numbere N, Huber AR, Shi C, Cates JMM, Gonzalez RS. Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours? Histopathology. 2019 Feb;74(3):424–429.
Journal cover image

Published In

Histopathology

DOI

EISSN

1365-2559

Publication Date

February 2019

Volume

74

Issue

3

Start / End Page

424 / 429

Location

England

Related Subject Headings

  • Proportional Hazards Models
  • Pathology
  • Neuroendocrine Tumors
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Ki-67 Antigen
  • Intestine, Small
  • Intestinal Neoplasms
  • Immunohistochemistry