Reliability and agreement of radiological and pathological tumor size in patients with multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors: results from a population-based cohort

Beek, D.J. van; Verkooijen, H.M.; Nell, S.; Bonsing, B.A.; Eijck, C.H. van; Goor, H. van; ... ; Vriens, M.R. (2021)

Article / Letter to editor

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 (MRI, 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 73 included patients, the median radiological and pathological tumor sizes measured were 22 (3-160) and 21 (4-200) mm, respectively. Mean bias between radiological and pathological tumor size was -0.2 mm and LoA ranged from -12.9 to 12.6 mm. 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 values of MRI, CT, and EUS were 88.6, 85.7, and 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.

• Magnetic resonance imaging
• Endoscopic ultrasonography
• Multiple endocrine neoplasia type 1
• Pancreatic neuroendocrine tumor
• Reliability
• Agreement
• Computed tomography

• All authors: Beek, D.J. van; Verkooijen, H.M.; Nell, S.; Bonsing, B.A.; Eijck, C.H. van; Goor, H. van; Hoogwater, F.J.H.; Dijkum, E.J.M.N. van; Kazemier, G.; Dejong, C.H.C.; Brosens, L.A.A.; Wessels, F.J.; Rinkes, I.H.M.B.; Valk, G.D.; Vriens, M.R.
• Date: 2021-07-01
• Journal: Neuroendocrinology
• Volume: 111
• Issue: 8
• Pages: 705 - 717
• DOI: doi:10.1159/000510514
• Link: https://www.karger.com/Article/Pdf/510514