Background: Pancreatic neuroendocrine tumors (pNETs) have a high prevalence in patients with multiple endocrine neoplasia type 1 (MEN1) and are the leading cause of death. Tumor size is still regarded as the main prognostic factor and therefore used for surgical decision making. We assessed reliability and agreement of radiological and pathological tumor size in a population-based cohort of patients with MEN1-related pNETs. Methods: Patients were selected from the Dutch MEN1 database if they had undergone a resection for a pNET between 2003 and 2018. Radiological (magnetic resonance imaging (MRI), computed tomography (CT) and endoscopic ultrasonography (EUS)) and pathological tumor size were collected from patient records. Measures of agreement (Bland-Altman plots with limits of agreement (LoA) and absolute agreement) and reliability (Intraclass Correlation Coefficients (ICC) and unweighted Kappa) were calculated for continuous and categorized (< or ≥ 2 cm) pNET size. Results: In seventy-three included patients, the median radiological and pathological tumor size measured was 22 [3 – 160] and 21 [4 – 200] mm, respectively. Mean bias between radiological and pathological tumor size was -0.2mm and LoA ranged from -12.9 to 12.6mm. For the subgroups of MRI, CT and EUS, LoA of radiological and pathological tumor size ranged from -9.6 to 10.9, -15.9 to 15.8 and -13.9 to 11.0, respectively. ICCs for the overall cohort, MRI, CT and EUS were 0.80, 0.86, 0.75 and 0.76, respectively. Based on the 2 cm criterion, agreement was 81.5%, hence 12 patients (18.5%) were classified differently between imaging and pathology. Absolute agreement and kappa’s of MRI, CT and EUS were 88.6%, 85.7%, 75.0% and 0.77, 0.71 and 0.50, respectively. Conclusion: Within a population-based cohort, MEN1-related pNET size was not systematically over-, or underestimated on preoperative imaging. Based on agreement and reliability measures, MRI is the preferred imaging modality.


中文翻译：

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MEN1 相关胰腺神经内分泌肿瘤患者放射和病理肿瘤大小的可靠性和一致性：基于人群的队列结果。

背景：胰腺神经内分泌肿瘤 (pNETs) 在多发性内分泌肿瘤 1 型 (MEN1) 患者中的患病率很高，是导致死亡的主要原因。肿瘤大小仍然被认为是主要的预后因素，因此用于手术决策。我们评估了基于人群的 MEN1 相关 pNET 患者队列中放射学和病理学肿瘤大小的可靠性和一致性。方法：从荷兰 MEN1 数据库中选择在 2003 年至 2018 年间接受过 pNET 切除术的患者。放射学（磁共振成像 (MRI)、计算机断层扫描 (CT) 和超声内镜 (EUS)）和病理肿瘤大小是从病历中收集。计算了连续和分类（< 或 ≥ 2 cm）pNET 大小的一致性测量（具有一致性限制 (LoA) 和绝对一致性的 Bland-Altman 图）和可靠性（类内相关系数 (ICC) 和未加权 Kappa）。结果：在纳入的 73 名患者中，测量的中位放射学和病理学肿瘤大小分别为 22 [3 – 160] 和 21 [4 – 200] mm。放射学和病理学肿瘤大小之间的平均偏差为 -0.2mm，LoA 范围为 -12.9 至 12.6mm。对于 MRI、CT 和 EUS 亚组，放射学和病理学肿瘤大小的 LoA 范围分别为 -9.6 至 10.9、-15.9 至 15.8 和 -13.9 至 11.0。整个队列、MRI、CT 和 EUS 的 ICC 分别为 0.80、0.86、0.75 和 0.76。基于 2 cm 标准，一致性为 81.5%，因此有 12 名患者（18. 5%）在影像学和病理学之间进行了不同的分类。MRI、CT和EUS的绝对一致性和kappa分别为88.6%、85.7%、75.0%和0.77、0.71和0.50。结论：在基于人群的队列中，MEN1 相关的 pNET 大小在术前成像中并未系统地高估或低估。基于一致性和可靠性测量，MRI 是首选的成像方式。