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Ki-67 labeling: a more sensitive indicator of malignant phenotype than mitotic count or tumor size?
Kevin Lowe1, Amit Khithani, Elizabeth Liu
1Department of HPB Surgery, Methodist Dallas Medical Center, Dallas, Texas 75208, USA.
Background And Objectives:
The Ki-67 index has been incorporated into The World Health Organization's classification system of pancreatic neuroendocrine tumors. However, pathologists continue to question the utility of Ki-67 index over that of mitotic count as an indicator of proliferative activity. The intent of the current study is to compare K-i67 index with tumor size and mitotic rate for the association of each with lymph node metastasis and survival.
Methods:
The current study is a review of 24 patients with pancreatic neuroendocrine tumors.
Results:
Regional LNM were present in 100% of tumors with Ki-67 index >10%, while only 25% of tumors with <10% Ki-67 had LNM (P = 0.003). No tumors <2 cm had >10% Ki-67 labeling. Of patients with tumors showing ≥ 10% Ki-67 labeling, 80% died during the observation period of this study, while during the same time period, no patients with <10% Ki-67 labeling died.
Conclusion:
Ki-67 index of >10% is a sensitive indicator of malignant behavior and mortality. Future advances in management of pNETs will require development of staging guidelines with higher predictive value. Inclusion of Ki-67 labeling >10% as an indicator of aggressive disease may contribute to such improvements.
