Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading

Table 1 Comparison of specimens obtained by endoscopic ultrasonography-guided fine needle aspiration and surgery

	Sex	Age (yr)	Size (mm)	Location of tumor	No. of needle passes	Needle (G)	EUS-FNA specimen		Surgery specimen
							Ki-67 index	Grade	Ki-67 index	Mitotic count (/10HPF)	Grade
1	M	71	4.4	Tail	5	19	< 2.0%	G1	< 2.0%	0	G1
2	F	79	19	Head	4	22	0.8%	G1	< 2.0%	0	G1
3	M	44	31	Head	2	22	1.8%	G1	0.1%	0	G1
4	F	51	10	Body	3	22	0.4%	G1	1.97%	0	G1
5	M	75	40	Tail	3	22	7.0%	G2	7.13%	2	G2
6	M	49	31	Body	3	22	4.54%	G2	< 20%	11	G2
7	F	46	30	Head	3	22, 25	< 2.0%	G1	7.5%	15	G2
8	M	55	40	Head	2	25	1.8%	G1	< 1.0%	0	G1

Tumor grades were concordant between specimens of EUS-FNA and those obtained by operation, except in case no. 7. The concordance rate between specimens of EUS-FNA and surgery was 87.5% (7/8). M: Male; F: Female; EUS-FNA: Endoscopic ultrasonography-guided fine needle aspiration.

Table 2 Prognosis of patients treated by chemotherapy

	Sex	Age (yr)	Size (mm)	Location of tumor	No. of needle passes	Needle (G)	Metastasis	EUS-FNA		Therapy	Prognosis
								Ki-67 index	Grade
1	M	64	45	Head	3	22	Liver	10.0%	G2	Everolimus	PR
										TAI	15 mo survival antemortem
2	M	73	30	Tail	1	22	Liver	48.6%	NEC	IP→PE	PR
										TAI	12 mo survival antemortem

Two cases were treated by chemotherapy due to multiple liver metastases. Case 1 was diagnosed with NET G1 by EUS-FNA and was started on somatostatin analog therapy. After that, the patient began taking everolimus. Case 2 was diagnosed as NEC by EUS-FNA and therefore started on cisplatin and irinotecan therapy. However, severe adverse effects, including renal failure and diarrhea, were observed; therefore, the regimen was changed to cisplatin and etoposide. In these two cases, transcatheter arterial infusion targeting the multiple liver metastases was performed. During treatment, the primary tumors remained unconfirmed, but the multiple liver metastases diminished dramatically in both cases. M: Male; TAI: Transcatheter arterial infusion; IP: Cisplatin and irinotecan therapy; PE: Cisplatin and etoposide therapy; PR: Partial response; NETs: Neuroendocrine tumors; NEC: Neuroendocrine carcinoma; EUS-FNA: Endoscopic ultrasonography-guided fine needle aspiration.