Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2025; 17(5): 104808
Published online May 28, 2025. doi: 10.4329/wjr.v17.i5.104808
Computed tomography-guided percutaneous biopsy for assessing tumor heterogeneity in neuroendocrine tumor metastases to the liver
Lei-Lei Ying, Ke-Ning Li, Wen-Tao Li, Xin-Hong He, Chao Chen
Lei-Lei Ying, Ke-Ning Li, Wen-Tao Li, Xin-Hong He, Chao Chen, Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Lei-Lei Ying, Ke-Ning Li, Wen-Tao Li, Xin-Hong He, Chao Chen, Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Co-first authors: Lei-Lei Ying and Ke-Ning Li.
Co-corresponding authors: Xin-Hong He and Chao Chen.
Author contributions: Ying LL, Li KN, and Chen C wrote the original draft; Ying LL and Li KN contributed equally to this article, they are the co-first authors of this manuscript; Li WT and He XH made thoroughly review and editing of the manuscript; Li WT, He XH, and Chen C designed the study and performed the core needle biopsy procedure as well as documented all data related to percutaneous computed tomography-guided core needle biopsy; Ying LL and Chen C designed the methodology of study and analyzed all data; Ying LL, Li KN, Li WT, He XH, and Chen C contributed to editorial changes in the manuscript; He XH and Chen C contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82072034.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Fudan University Shanghai Cancer Center, approval No. 1612167-18.
Informed consent statement: Informed consent was waived by the Institutional Review Board of Fudan University Shanghai Cancer Center (Approval No. 2011226-4) for this retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during this study are not publicly available due to institutional ethical regulations and patient confidentiality protections. However, de-identified data supporting the findings of this study are available from the corresponding author (Chao Chen, chaochen_cc@fudan.edu.cn) upon reasonable request. Data requests will be reviewed by the institutional ethics committee to ensure compliance with privacy policies. Approved requests may require a formal data sharing agreement outlining terms of use, including prohibitions on re-identification attempts and restrictions on redistribution. All shared data will remain anonymized, consistent with the original study protocol.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao Chen, MD, PhD, Department of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui District, Shanghai 200032, China. chaochen_cc@fudan.edu.cn
Received: January 3, 2025
Revised: April 9, 2025
Accepted: May 8, 2025
Published online: May 28, 2025
Processing time: 143 Days and 23.1 Hours
Abstract
BACKGROUND

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) frequently metastasize to the liver, with heterogeneity in tumor grade impacting patient prognosis and treatment. The Ki-67 index, a key prognostic marker, often varies between primary and metastatic sites; however, routine liver biopsy remains controversial. Although percutaneous computed tomography-guided core needle biopsy (PCT-CNB) is safe and effective for focal lesions, its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored. Conflicting survival associations with grade shifts have been reported in previous studies. We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases, correlating with survival outcomes, thereby refining risk stratification and therapeutic strategies.

AIM

To investigate intertumor grading heterogeneity in GEP-NET liver metastases via PCT-CNB.

METHODS

We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB, 76 patient samples from the liver and primary sites, and 16 from the liver and secondary liver sites. Ki-67 immunohistochemistry was performed for tissue sampling, and grading classifications were determined. Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.

RESULTS

No procedure-related mortality was recorded during or after biopsy. In 37/92 patients (40.2%), the grading classifications changed: The grading increased from G1 to G2 in 13 patients, from G1 to G3 in 2, and from G2 to G3 in 14; the grading decreased from G2 to G1 in 5 patients, from G3 to G1 in 1, and from G3 to G2 in 2. Patients with G1 or G2 disease had better progression-free survival and overall survival (OS) outcomes than those with G3 disease did (P = 0.001 and P < 0.001, respectively). The 5-year and 10-year OS rates for stable G2 patients were 67.5% and 26.0%, respectively, decreasing to 46.4% and 23.2%, respectively, among G2 patients whose grade increased (P = 0.016).

CONCLUSION

The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases. Additionally, when grading increased from G2, the OS rate significantly decreased.

Keywords: Image-guided core needle biopsy; Gastroenteropancreatic neuroendocrine tumors; Liver metastases; Survival; Tumor heterogeneity

Core Tip: This study demonstrates that percutaneous computed tomography-guided core needle biopsy effectively identifies clinically significant grading heterogeneity in liver metastases from gastroenteropancreatic neuroendocrine tumors. Notably, 40.2% of patients exhibited grade discrepancies between primary and metastatic sites, with upgraded tumors (e.g., G2 to G3) correlating with markedly reduced overall survival. These findings emphasize percutaneous computed tomography-guided core needle biopsy’s pivotal role in optimizing risk stratification, informing personalized therapeutic decisions (e.g., intensified surveillance or targeted therapies), and improving prognostic accuracy for gastroenteropancreatic neuroendocrine tumor patients, while confirming its safety and diagnostic reliability in clinical practice.