What are grading schemes for insulinoma?

Updated: May 31, 2020
  • Author: Zonera Ashraf Ali, MBBS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Grading schemes for neuroendocrine tumors (NETs) use mitotic count; the level of the nuclear protein Ki-67, which is associated with cellular proliferation; and assessment of necrosis. The World Health Organization (WHO) and the European Neuroendocrine Tumor Society (ENETS)  both incorporate mitotic count and Ki-67 proliferation for the classification of gastroenteropancreatic NETs (GEP-NETs). [56, 57, 58]

Tumors fall into one of the following three grades [59] :

  • G1: Mitotic count < 2/2 mm 2 (10 high-power fields); Ki-67 index < 3%
  • G2: Mitotic count < 2-20/2 mm 2; Ki-67 index 3-20%
  • G3: Mitotic count > 20/2 mm 2; Ki-67 index > 20%

G1 and G2 NETs are well differentiated; as a rule, G3 NETs are poorly differentiated, but rarely may be well differentiated. [39]


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