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- 请教肿瘤免疫组化Ki67如何评估？
| 以下是引用谈东风在2010-12-8 3:46:00的发言：
Ki-67 index is one of the variables to consider. It must be used in conjunction with histology/morphology. I recently had a case of GI neuroendocrine tumor. At lower power, it is a carcinooid. At higher power view, I saw focally increased mitosis, about 3 per 10 HPF. No necrosis is seen. Therefore, it was consistent with intermediate neuroendocrine tumor. The fellow stained the tumor with Ki-67, and revealed 50% positive cells. But I still signed out as "neuroendocrine tumor, favor intermediate grade" and wrote a comment to explain the histology and Ki-67 findings. Clinical correlation is also helpful, usually high-grade tumor progresses aggressively.
Besides counting the Ki-67 staining, some places also use automatic imaging analysis to record the percentage. |
| 以下是引用ths35在2010-12-4 23:43:00的发言：
NET G1 Mitotic count <2/10HPF and /or Ki-67 index <=2% NET G2 Mitotic count 2-20/10HPF and /or Ki-67 index >2%-20% NET G3 Mitotic count >2010/HPF and /or Ki-67 index >20%% 老师也就是说大于20%，不论是百分多少值，都是高增殖活性G3。 |
Ki-67 index is one of the variables to consider. It must be used in conjunction with histology/morphology. I recently had a case of GI neuroendocrine tumor. At lower power, it is a carcinooid. At higher power view, I saw focally increased mitosis, about 3 per 10 HPF. No necrosis is seen. Therefore, it was consistent with intermediate neuroendocrine tumor. The fellow stained the tumor with Ki-67, and revealed 50% positive cells. But I still signed out as "neuroendocrine tumor, favor intermediate grade" and wrote a comment to explain the histology and Ki-67 findings. Clinical correlation is also helpful, usually high-grade tumor progresses aggressively.
Besides counting the Ki-67 staining, some places also use automatic imaging analysis to record the percentage.
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本帖最后由 于 2010-11-30 06:56:00 编辑
WHO2010消化道肿瘤分类中有一个非常大的改变是胃肠道神经内分泌肿瘤(Neuroendocrine neoplasms)
1）分类( classification)
NET G1(类癌）
NET G2
NEC
2）分级( grading)
NET G1 Mitotic count <2/10HPF and /or Ki-67 index <=2%
NET G2 Mitotic count 2-20/10HPF and /or Ki-67 index >2%-20%
NET G3 Mitotic count >2010/HPF and /or Ki-67 index >20%%
对于Ki-67指数要求选择“hot spots", 计算500-2000个肿瘤细胞中Ki-67+的百分数。
在即将出版的 Am J Surg Pathology 2010 "Pathology reporting of neuroendocrine tumors" 一文中对Ki-67 指数有专门的评述。其中讲到：目前实用的方法是用“Eye-Balled”， 但可重复性差，将来要用形态仪计数单位面积内的Ki-67 + 细胞数。
对于Ki-67指数在软组织肿瘤中的意义，Dr.Fletcher在（2010-10） 第28届国际病理学术会议上的大会演讲中评论到，“他从来就不用Ki-67指数来表示软组织肿瘤的增殖活性”。
供参考，谢谢！
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