Comparison of Methods for Proliferative Index Analysis for Grading Pancreatic Well-Differentiated Neuroendocrine Tumors
Comparison of Methods for Proliferative Index Analysis for Grading Pancreatic Well-Differentiated Neuroendocrine Tumors
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DOI：
10.1309/ajcp92ucxpjmmsdu
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发表时间：
2012-04-01
影响因子：
3.5
通讯作者：
Hartman, Douglas J.
中科院分区：
文献类型：
--
作者：
Goodell, Pamela P.;Krasinskas, Alyssa M.;Hartman, Douglas J.
对分化良好的胰腺神经内分泌肿瘤进行分级需要评估增殖活性。然而，一个标准化的方法来获得Ki-67增殖指数是缺乏的。本研究比较了通过3种方法获得的增殖活性：使用Ventana图像分析系统（Ventana Medical Systems，图森，亚利桑那州）的单场热点（Ki-67 HS）和10个连续场平均值（Ki-67 CFA）和有丝分裂指数（MI）。这些方法导致我们45例病例中30例（67%）的分级不一致。由于目前Ki-67临界值大于2%的中等级别肿瘤，MI、CFA和HS检测转移的特异性分别为91%、94%和31%，阳性预测值（PPV）分别为25%、67%和31%。在较高的Ki-67临界值7.5%时，HS分析预测转移的特异性为94%，PPV为71%。虽然单场HS分析在较高的临界值下可能是实用和可靠的，但本研究强调了使用不同评估方法时可能存在的变异性。
Assessment of proliferative activity is required for grading well-differentiated pancreatic neuroendocrine tumors. However, a standardized method for obtaining the Ki-67 proliferative index is lacking. This study compared proliferative activity obtained by 3 methods: single-field hot spot (Ki-67 HS) and 10 consecutive field average (Ki-67 CFA) using the Ventana image analysis system (Ventana Medical Systems, Tucson, AZ) and mitotic index (MI). These methods resulted in discrepant grades in 30 (67%) of our 45 cases. With the current Ki-67 cutoff of more than 2% for intermediate-grade tumors, MI, CFA, and HS resulted in specificities of 91%, 94%, and 31%, respectively, for detecting metastasis, with positive predictive values (PPVs) of 25%, 67%, and 31%, respectively. At a higher Ki-67 cutoff of 7.5%, HS analysis resulted in a specificity of 94% and PPV of 71% for predicting metastasis. While single-field HS analysis may be practical and reliable at a higher cutoff this study emphasizes the variability that can exist when different methods of assessment are used.