Lesion-by-lesion correlation between uptake at FDG PET and the Ki67 proliferation index in resected pancreatic neuroendocrine tumors

• Published in: Digestive and liver disease Vol. 51; no. 12; pp. 1720 - 1724
• Main Authors: de Mestier, Louis, Armani, Margot, Cros, Jérôme, Hentic, Olivia, Rebours, Vinciane, Cadiot, Guillaume, Sauvanet, Alain, Couvelard, Anne, Lebtahi, Rachida, Ruszniewski, Philippe
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2019; Elsevier
• Subjects: Biomarkers, Tumor - analysis; Cell Proliferation; FDG-PET; Female; Fluorodeoxyglucose F18 - pharmacology; Grade; Humans; Immunohistochemistry; Ki-67 Antigen - analysis; Ki67; Life Sciences; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Lymphatic Metastasis - diagnostic imaging; Male; Middle Aged; Neuroendocrine tumors; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - surgery; Pancreas; Pancreatectomy - methods; Pancreatectomy - statistics & numerical data; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Positron-Emission Tomography - methods; Radiopharmaceuticals - pharmacology; Reproducibility of Results; FDG-PET; Grade; Ki67; Pancreas; Neuroendocrine tumors
• ISSN: 1590-8658; 1878-3562; 1878-3562
• DOI: 10.1016/j.dld.2019.06.022

Ki67 proliferation index and tumor uptake on 18fluorodeoxyglucose positron-emitting tomography (FDG-PET) could be correlated in pancreatic neuroendocrine tumors (PanNET), but the evaluation of the former is subject to tumor heterogeneity. Explore the correlation between Ki67 and FDG-PET uptake at the lesion scale in PanNET. We identified target lesions ≥10 mm in patients operated on for a PanNET and/or associated metastases with preoperative FDG-PET and without neoadjuvant treatment. We assessed the lesion-by-lesion correlation between Ki67 and the tumor-to-liver SUVmax ratio (SUVmax T/L), and between pathological grade (G) and metabolic grade (mG) (mG1, SUVmax T/L ≤ 1, mG2, SUVmax T/L 1–2.3 and mG3, SUVmax T/L > 2.3). Twenty-one patients underwent pancreatic (n = 12), liver (n = 2) or combined surgery (n = 7). Overall, 36 target lesions (21 primary PanNET, 13 liver metastases and 2 lymph-node metastases) were identified, of median Ki67 4%. Ki67 correlated with SUVmax T/L (r = 0.55, p < 0.001). Median SUVmax T/L was 0.76, 1.41 and 2.67 for lesions G1, G2 and G3, respectively (p = 0.005). Median Ki67 was 1, 4 and 25 for lesions mG1, mG2 and mG3, respectively (p = 0.005). Uptake on FDG-PET could predict the pathological grade of PanNET lesions. Hence, FDG-PET could supplement pathological evaluation of tumor biological aggressiveness and could guide the choice of the most relevant lesions to biopsy.