Background and Aims
Therapy and prognosis of pancreatic neuroendocrine tumors (PanNETs) are strictly related
to the Ki-67 index, which defines tumor grading. The criterion standard for the assessment
of grading of PanNETs is EUS-guided FNA (EUS-FBAFNA) or EUS-guided fine-needle biopsy
sampling (EUS-FNB). Because data on diagnostic accuracy of EUS-FNA and EUS-FNB are
heterogeneous, we aimed to analyze the variability in concordance between EUS grading
and surgical grading.
Methods
The MEDLINE, SCOPUS, and EMBASE databases were searched until November 2021 to identify
studies reporting the concordance rate between EUS grading and surgical grading. The
study was conducted in accordance with Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. Pooled events were calculated using a random-effects
model and expressed in terms of pooled prevalence rates. A multivariate meta-regression
was performed to find possible sources of heterogeneity. Where available, individual
data were analyzed.
Results
Twenty-six studies with 864 patients undergone EUS-FNA or EUS-FNB and surgical resection
for PanNETs were included. The pooled estimate rate for the overall concordance of
EUS grading and surgical grading was 80.3% (95% confidence interval, 75.6-85.1). Undergrading
(EUS grading < surgical grading) was significantly more frequent with respect to overgrading
(14.7% vs 3.5%, P < .001). Individual data analysis showed that among nonconcordant patients, the median
Ki-67 difference was 3% (interquartile range, 2-6.15). The type of World Health Organization
classification adopted and the median lesion diameter were significantly associated
with heterogeneity at meta-regression.
Conclusions
EUS is an accurate technique in defining grading in patients with PanNETs, but a margin
of error still exists, which should be the focus of future studies to minimize the
risk of over- and/or undertreatment.
Abbreviations:
EUS-FNB (EUS-guided fine-needle biopsy sampling), PanNET (pancreatic neuroendocrine tumor), WHO (World Health Organization)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 18, 2022
Accepted:
July 8,
2022
Received:
February 7,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the language of the study questionnaires reflected inclusion.
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
