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- Title
Challenges in Ki‐67 assessments in pulmonary large‐cell neuroendocrine carcinomas*.
- Authors
Walts, Ann E; Mirocha, James M; Marchevsky, Alberto M
- Abstract
Aims: To gather the best available evidence regarding Ki‐67% values in large‐cell neuroendocrine carcinoma (LCNEC) and determine whether certain cut‐off values could serve as a prognostic feature in LCNEC. Methods and results: Aperio ScanScope AT Turbo, eSlide Manager and ImageScope software (Leica Biosystems) were used to measure Ki‐67% in 77 resected LCNEC diagnosed by World Health Organisation (WHO) criteria. Cases were stratified into six classes by 10% Ki‐67 increments. Using the Kaplan–Meier method, overall (OS) and disease‐free survivals (DFS) were compared by AJCC stage, by six Ki‐67% classes and with Ki‐67% cut‐points ≥20% and ≥40%. Tumours were from 0.9 to 11.5 cm and pathological stages 1–3. The system measured Ki‐67% positivity using 4072–44 533 tumour nuclei per case (mean 16610 ± 8039). Ki‐67% ranged from 1 to 64% (mean = 26%; median = 26%). Only 16 (21%) tumours had Ki‐67% ≥40%. OS ranged from 1 to 298 months (median follow‐up = 25 months). DFS ranged from 1 to 276 months (median follow‐up = 9 months). OS and DFS differed across AJCC stage (overall log‐rank P = 0.038 and P = 0.037). However, neither OS nor DFS significantly correlated with Ki‐67% when six or two classes were used with either ≥20% Ki‐67 or ≥40% Ki‐67 as cut‐point. A literature review identified 14 reports meeting our inclusion criteria with ≥10 LCNEC. Reported Ki‐67% ranged from 2% to 100%. Problems contributing to variability in Ki‐67% measurements are discussed. Conclusion: Our findings caution against a blanket use of 20%, 40% or other Ki‐67% cut‐points for LCNEC diagnosis or prognostication.
- Subjects
WORLD Health Organization; KI-67 antigen; PROGRESSION-free survival; DIAGNOSIS; BIOLOGICAL systems; LITERATURE reviews
- Publication
Histopathology, 2021, Vol 78, Issue 5, p699
- ISSN
0309-0167
- Publication type
Article
- DOI
10.1111/his.14277