CT features of gastric stromal tumors in predicting Ki-67 index expression / 中华普通外科杂志

Objective:To investigate the feasibility of multi-slice spiral CT (MSCT) imaging feature of gastric stromal tumor (GST) in evaluating Ki-67 index expression .Methods:The clinical and CT imaging data of 501 patients with GST confirmed by surgery and pathology were retrospectively studied in Zhongshan Hospital affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University from Nov 2014 to Nov 2021. By immunohistochemical results, tumors were divided into Ki-67 low expression group (Ki-67≤6%, 335 lesions) and high expression group (Ki-67>6%, 168 lesions). Multivariate logistic regression analysis was conducted.Results:Between the two groups,there were statistical differences in the longest and shortest diameter of tumor, CT value on venous phase, CT attenuation value ( Z=4.80, 4.91, 3.21, 3.29, all P<0.01) and tumor location,morphology, necrosis, ulcer, feeding artery, vascular enhancement, positive fat sign around disease, gastrointestinal bleeding ( χ2=10.77, 13.49, 8.59, 22.87, 7.59, 7.23, 7.76, 8.58, all P<0.05). Tumor ulceration positive ( OR=1.88, 95%CI: 1.17-3.03) was independent risk factor of Ki-67 high expression ( P=0.009). Gastric antrum was used as the reference for tumor location, cardia ( OR=5.41, 95% CI:1.25-23.46) was independent risk factor of Ki-67 high expression ( P=0.024). Conclusion:MSCT has a definite predictive value for the expression in Ki-67 index of GST cases.

Correlation analysis of contrast-enhanced ultrasound Liver Imaging Reporting and Data System classification with hepatocellular carcinoma differentiation and Ki-67 index / 中华超声影像学杂志

Objective:To investigate the correlation of hepatocellular carcinoma (HCC) classified by contrast-enhanced ultrasound (CEUS) Liver Imaging Data and Report System (LI-RADS) with differentiation degree and Ki-67 index.Methods:A multicenter, retrospective study was conducted.The clinical and CEUS imaging data of 208 patients with 208 HCC lesions from December 2017 to December 2020 in China CEUS database were included and analyzed. According to the CEUS LI-RADS version 2017 proposed by the American College of Radiology, the HCC was classified. The diagnosis and pathological information of all lesions were confirmed by pathology. The differentiation degree of HCC and the distribution of Ki-67 index in different LI-RADS categories were evaluated, and their correlation was analyzed.Results:The degree of differentiation and Ki-67 index among HCC of different CEUS LI-RADS were statistically significant ( P<0.001, P=0.009). LI-RADS M HCC was more likely to be poorly differentiated and showed a higher Ki-67 index. The category of LI-RADS was positively correlated with the degree of tumor differentiation (tau-b=-0.250, P<0.001) and the Ki-67 index (tau-b=0.178, P=0.002), that is, the higher the category of LI-RADS, the lower differentiation degree and the higher the Ki-67. Conclusions:The CEUS LI-RADS classification of HCC is correlating with the degree of differentiation and Ki-67 index.

Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding: A retrospective comparative study

Context: Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs. Aims: To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type. Methods and Material: Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups – Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done. Statistical Analysis: Chi-square test, univariate and multivariate logistic regression models were used. Results: Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades.Conclusions: TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.

The value of 18F-FDG PET-CT imaging in predicting the malignant potential of GIST / 中华肿瘤杂志

Objective@#To evaluate the value of 18F-FDG PET-CT in predicting the malignant potential of Gastrointestinal Stromal Tumors (GIST).@*Methods@#The clinical and pathological features of 31 patients with GIST confirmed by surgery or biopsy were retrospectively analyzed. The malignant potential of GIST before treatment was assessed by 18F-FDG PET-CT. The GIST risk classification was graded according to the Standard revised by the National Institutes of Health (NIH) in 2008. The relationship between the maximal standard uptake value (SUVmax) and GIST risk classification, tumor diameter, Ki-67 index, and mitotic count were analyzed respectively. The cut-off level of SUVmax for the diagnosis of malignant GIST was calculated from the Receiver Operating Characteristic (ROC) curve.@*Results@#Among the 31 cases of GIST patients, 14 cases were gastric primary (stomach group) and 17 cases were nongastric primary (outside stomach group). The SUVmax, tumor diameter, Ki-67 index and mitotic count of the 31 patients were 8.21±4.68, (7.82±5.12)cm, (10.03±11.07)% and (12.29±10.55)/50 HPF, respectively. SUVmax was significantly correlated with GIST risk classification (r=0.727, P<0.01), but not with tumor diameter, Ki-67 index and mitotic count (r=0.348, r=0.284, r=0.290, P=0.055, P=0.121, P=0.114). The SUVmax, tumor diameter, Ki-67 index and mitotic count in the stomach group were 4.36±2.36, (6.08±4.31)cm, (3.43±3.03)% and (5.71±2.20)/50 HPF, respectively. SUVmax was significantly correlated with tumor diameter, GIST risk classification and Ki-67 index (r=0.682, r=0.868, r=0.732, P<0.01) but not with mitotic count (r=0.510, P=0.063). The SUVmax of the GIST in the gastric group and the outside gastric group were 4.36±2.36 and 10.68±5.50, respectively. The difference was statistically significant (P=0.001). The SUVmax in the malignant group of GIST (middle or high risk grade) was 8.90±4.89, which was significantly higher than 2.22±0.86 in the benign group (low or very low risk grade). The difference was statistically significant between the two group (P<0.01). ROC curve analysis showed that a SUVmax cut-off of 3.75 was the most sensitive for predicting malignant GIST. When the area under the curve of 0.969, the sensitivity was 84.6% and the specificity was 100%.@*Conclusions@#The SUVmax was strongly correlated with the GIST risk category and also with the tumor diameter and Ki-67 index in the gastric primary GIST, so it can be used as an effective indicator in predicting malignant potential of GIST before treatment.

Advances in diagnosis and treatment of thymic carcinoid / 基础医学与临床

Thymic carcinoid is a rare neoplasm with unclear risk factors and controversial classifications .Clinical manifestations vary from asymptomatic to many nonspecific symptoms , among which endocrinopathy seems to be as-sociated with poor prognosis .Image studies show no specificity both in CT and PET/CT, but are of great value in clinical staging .Ki67 index has been found to be a powerful tool for grading neuroendocrine tumors and further studies should be made .The diagnosis of thymic carcinoid mainly depends on pathology and immunohistochemistry plays a role in differential diagnosis .Radical resection is the first choice in treatment , and target therapy becomes possible with the development in molecular pathology .

Cerebellar Liponeurocytoma with an Unusually Aggressive Histopathology : Case Report and Review of the Literature

We report a rare case of cerebellar liponeurocytoma with an unusually aggressive histopathology. A 49-year-old man presented with a four-month history of headache, vertigo, and progressive swaying gait. Magnetic resonance imaging showed a 3x3.5 cm sized relatively well-demarcated round mass lesion in the fourth ventricle, characterized by high signal intensity on T2-weighted images. Postcontrast images revealed strong enhancement of the solid portion and the cyst wall. The patient underwent suboccipital craniectomy and tumor removal. The pathologic diagnosis was cerebellar liponeurocytoma. Adjuvant radiotherapy was offered due to concerns related to the high proliferative index (Ki-67, 13.68%) of the tumor. At the last routine postoperative follow-up visit (12 months), the patient complained of no specific symptom and there was no evidence of tumor recurrence. However, long-term follow-up and the analysis of similar cases are necessary because of the low number of reports and the short follow-up of cases.

Role of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Gastric GIST: Predicting Malignant Potential Pre-operatively

PURPOSE: It is difficult to obtain biopsies from gastrointestinal stromal tumors (GISTs) prior to surgery because GISTs are submucoal tumors, despite being the most common nonepithelial neoplasms of the gastrointestinal tract. Unlike anatomic imaging techniques, PET-CT, which is a molecular imaging tool, can be a useful technique for assessing tumor activity and predicting the malignant potential of certain tumors. Thus, we aimed to evaluate the usefulness of PET-CT as a pre-operative prognostic factor for GISTs by analyzing the correlation between the existing post-operative prognostic factors and the maximum SUV uptake (SUVmax) of pre-operative 18F-fluoro-2-deoxyglucose (FDG) PET-CT. MATERIALS AND METHODS: The study was conducted on 26 patients who were diagnosed with gastric GISTs and underwent surgery after being examined with pre-operative FDG PET-CT. An analysis of the correlation bewteen (i) NIH risk classfication and the Ki-67 proliferation index, which are post-operative prognostic factors, and (ii) the SUVmax of PET-CT, which is a pre-operative prognostic factor, was performed. RESULTS: There were significant correlations between (i) SUVmax and (ii) Ki-67 index, tumor size, mitotic count, and NIH risk group (r=0.854, 0.888, 0.791, and 0.756, respectively). The optimal cut-off value for SUVmax was 3.94 between "low-risk malignancy" and "high-risk malignancy" groups. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7% and 94.7%, respectively. CONCLUSIONS: The SUVmax of PET-CT is associated with Ki-67 index, tumor size, mitotic count, and NIH classification. Therefore, it is believed that PET-CT is a relatively safe, non-invasive diagnostic tool for assessing malignant potential pre-operatively.

Analysis of Prognostic Factors in Gastrointestinal Stromal Tumors

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and are immunohistochemically defined as c-KIT (CD117) positive tumors. This study investigated the behaviors of GISTs of the gastrointestinal tract and determined the prognostic factors associated with GISTs. METHOD: The clinical records of 22 patients, who were diagnosed and underwent surgery for a GIST of the GI tract at Inje university Sanggye Paik hospital from 1998 to 2004, were retrospectively analyzed. The relationship between the disease-free survival rate of the GISTs and several factors including age, gender, mitotic count, tumor site, tumor size, tumor necrosis & hemorrhage, and Ki-67 index was examined. RESULTS: The study group comprised of 13 men and 9 women. The mean age was 57.1 years (31~77 years) at the time of diagnosis. The median follow-up period was 24 months (3~45 months). A complete resection of the tumor was performed in 19 patients. There were lymph node metastases in 1 case. Five out of the 19 patients who had undergone a complete tumor resection showed recurrence (27%). The sites of recurrence were the back (1), liver (1), and abdominal cavity (3). Univariate analysis revealed, the following to be prognostic factors for the disease-free survival of patients with GISTs: high power field mitotic counts of the tumor ( or =5/50; P=0.013), the tumor size ( or =5 cm; P=0.047) and the Ki-67 index ( or =5%; P=0.001). CONCLUSION: The prognostic factors for disease-free survival rate of GISTs were high power field mitotic counts of the tumor, the tumor size and the Ki-67 index. It is recommended that more careful and frequent postoperative follow-up examinations be performed for patients showing the poor prognostic factors.

Value of Elevated Ki67 Index (>10%) and p53 Protein Expression as Prognostic Factors in GISTs

PURPOSE: Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors and express CD117, the prediction of their malignant potential remains difficult. The aim of this study is to evaluate the prognostic accuracy of elevated Ki67 index and p53 overexpression in combination with classical prognostic factors (tumor size and mitotic index). METHODS: A retrospective study was conducted in 84 patients who had been re-evaluated for confirmation of diagnosis based on immunohistochemical analysis with CD117 expression, between Jan 1991 and Dec 2001. Cases were classified as very low, low, intermediate and high-risk groups according to 2001 NIH consensus symposium. Elevated Ki67 index was assigned to the lesion that displayed 10% or more of immunoreactive cells. And p53 expression was assigned to the area with 5% or more of eosinophilic nucleus. RESULTS: Elevated Ki67 was noted in 37 (44.0%) out of 84 cases. High-risk patients showed elevated Ki67 index more frequently (P<0.0001) and there was significant relation between elevated Ki67 and survival rate (P=0.0417). The p53 expression was noted in 32 (38.1%) out of 84 cases. The p53 expression was significantly higher in high-risk patients (P=0.0081) than low-risk patients. But, there was no significant relation between p53 expression and survival rate. As a result of multivariate analysis, tumor size (P=0.0059), mitotic index (P=0.0016) and elevated Ki67 index (P=0.0384) were proved as significant independent prognostic factors. CONCLUSION: According to the results of our retrospective study, p53 expression is related to disease progression but its value as a prognostic factor in GISTs is uncertain. It is suggested that tumor size, mitotic rate and elevated Ki67 index are the helpful prognostic factors in GISTs.

Evaluation of Glioma with Thallium-201 Brain SPECT : The Correlation with 1H MR Spectroscopy and Pathology / 대한핵의학회잡지

PURPOSE: Thallim-201 (201Tl) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201Tl brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. MATERIALS AND METHODS: We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201Tl Brain SPECT, 201Tl index was measured as the ratio of average counts for region of interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho) /creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. RESULTS: Tl-index showed the best correlation with Ki-67 index (p<0.01), less correlations with cellularity, mitosis, and endothelial proliferation, but no correlation with results of MRS, pleomorphism, or necrosis. The findings of MRS did not correlate with all of the above. The cases of glioblastoma demonstrated a higher Tl-index, Cho/Cr ratio, Ki-67 index and lower NAA/Cr ratio, albeit without statistical significance. CONCLUSION: Even though 201Tl brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation.

Epithelial Cell Proliferation, Apoptosis, and Apoptosis Inhibition in Inverted Papillomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inverted papillomas (IPs) are rare benign tumors of nasal epithelium with high recurrence rates and malignant transformation potential. Tumor development results from imbalance between cell proliferation and "programmed cell death", also named apoptosis. The purpose of this study was to compare cell proliferation, apoptosis, and apoptosis inhibition in hyperplastic epithelium from IPs and nasal polyps (NPs), and also to understand the mechanism of growth and malignant transformation of IPs. MATERIALS AND METHODS: IP samples were obtained after surgical removal of tumor in 15 patients, and NPs were sampled during endoscopic sinus surgery in 7 patients as a control. IP samples were classified in three groups: group I (n=9) -IP without dysplasia or carcinoma, group II (n=3) -IP with dysplasia, group III (n=3) -IP with carcinoma. Cell proliferation and apoptosis inhibition, respectively, were assessed by immunohistochemical identification of the Ki-67 and the oncoprotein Bcl-2. Apoptosis was evaluated by analyzing the DNA fragmentation using TUNEL method. RESULTS: Ki-67 index was increased in IPs compared to NPs (p=0.001). Of the IPs, Ki-67 index was increased progressively from IP without dysplasia or caccinoma, through IP with dysplasia, to reach the highest level in IP with carcinoma. Apoptotic index was also increased in IPs (p=0.002) with the highest level in IP without dysplasia or carcinoma. Of the IPs, apoptotic index was decreased as the tumor progress. Bcl-2 index was decreased in IPs (p=0.004), but, of the IPs, as the tumor progress, bcl-2 index was more decreased. CONCLUSION: Tumor development of IPs could result from the imbalance between hugely increasing epithelial cell proliferation and slightly increasing apoptosis, and the inhibition of apoptosis via bcl-2 oncoprotein seems to be involved in the growing process of IPs. Although we can not exactly mention due to limited number of cases, these imbalance may be involved in dysplastic or malignant transformation of IPs, but may be independent of the expression of bcl-2.

Ki-67 Index in the Head and Neck Squamous Cell Carcinomas and Tumor Adjacent Epithelia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Prognostic information is essential for the evaluation, judgement and optimal treatment of patients with head and neck squamous cell carcinoma. To evaluate the biological behavior of the malignancy, in particular, the proliferative activity of tumor cells were analyzed by proliferative markers, such as the Ki-67 index, PNCA and AgNOR. We performed this study to draw correlations between clinical findings and histopathologic prognostic factors using the Ki-67 index in the tumor tissues and the tumor adjacent epithelia. MATERIALS AND METHODS: The Ki-67 index of tumor tissues and the tumor adjacent epithelia from 24 patients with head and neck squamous cell carcinoma were analyzed using immunohistochemical methods. The relationships between the Ki-67 index in tumor tissues and tumor adjacent epithelia and several host and tumor factors were analyzed. RESULTS: The median Ki-67 index was higher in the tumor tissues than in the tumor adjacent epithelia (p<0.001). The ki-67 index of tumor tissues or tumor adjacent epithelia was not correlated with any host or tumor factor except N stage with tumor of interval to any treatment failure among the five variables which includes Ki-67 index, T stage, N stage, AJCC stage and age. Media interval to any treatment failure was shorter in groups with a high Ki-67 index than in groups with a low Ki-67 index of tumor tissue, but this result was statistically insignificant. CONCLUSION: The Ki-67 index was of little values in prognosis. However, among the various markers such as, the Ki-67 index, T stage, N stage, AJCC stage and age, the Ki-67 index of tumor tissue was the most significant predictor of interval to any treatment failure.

The prognostic significance of tumor angiogenesis, proliferating cell nuclear antigen(PCNA), and the Ki-67 index in carcinoma of the uterine cervix

Angiogenesis, the induction of new capillaries and venules, is associated with tumor growth. This study was designed to determine whether cervical carcinomas are angiogenic, and to investigate whether tumor angiogenesis can serve as a prognostic factor in cervical carcinoma. Surgical specimens of 47 cervical carcinomas were immunohistochemically stained specifically for endothelial cells with factor VIII-related antigen to identify all vessels. Microvessels were counted from photographs of 200x microscopic fields. In addition, thirty-seven cases were studied by immunohistochemical means using the monoclonal antibodies for PCNA and for Ki-67 to determine tumor cell proliferation rates in cervical carcinomas. The microvessel count(MVC), the PCNA labelling index, and the Ki-67 index were calculated and compared with known prognostic factors and disease free survival rates in cervical carcinomas. A wide range in the MVC count(range 12-100 mean=38.2+/-19.2), the PCNA labeling index(8-69% mean=33.6+/-15.2%), and in the extent of Ki-67 staining(0-43% mean=10.3+/-10.5%) was observed, indicating considerable variation of tumor angiogenic activity and tumor growth rates. This study showed statistically significant correlations in disease free survival rates with both lymph node status and the microvessel count. However, there was no significant difference in disease free survival rates between tumor stage, age, the PCNA labelling index, and the Ki-67 index.