ArticleDiagnostic cytopathology2020
Assessment of ARX expression, a novel biomarker for metastatic risk in pancreatic neuroendocrine tumors, in endoscopic ultrasound fine-needle aspiration.
Article in Diagnostic cytopathology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Prognostic factors for the outcome of nonfunctioning pancreatic neuroendocrine tumors in MEN1: a systematic review of literature.Endocrine-related cancer · 2020Pooled it
- Expression of ATRX, DAXX, PDX1, ARX, and somatostatin receptors in pancreatic neuroendocrine tumors: a clinicopathological study.Frontiers in endocrinology · 2026Article
- Extended Hormone Profiling Identifies a Wider Network of Duodenal Neuroendocrine Tumor Subtypes.Endocrine pathology · 2025Article
- Management of patients with small pancreatic neuroendocrine tumors from a biomarker and surgical perspective.Endocrine-related cancer · 2025Review
- Identification of the shared gene signatures in retinoblastoma and osteosarcoma by machine learning.Scientific reports · 2024Article
- Diagnostic and prognostic biomarkers for pancreatic neuroendocrine neoplasms.Pathologie (Heidelberg, Germany) · 2024Review
- Surgical Management and Long-Term Evaluation of Pancreatic Neuroendocrine Tumors.The Surgical clinics of North America · 2024Review
- Reprint of: The Diagnostic and Prognostic Utility of Incorporating DAXX, ATRX, and Alternative Lengthening of Telomeres (ALT) to the Evaluation of Pancreatic Neuroendocrine Tumors (PanNETs).Human pathology · 2023Review
- The diagnostic and prognostic utility of incorporating DAXX, ATRX, and alternative lengthening of telomeres to the evaluation of pancreatic neuroendocrine tumors.Human pathology · 2022Review
- Review
- An update on the development of concepts, diagnostic criteria, and challenging issues for neuroendocrine neoplasms across different digestive organs.Virchows Archiv : an international journal of pathology · 2022Review
- Article
- Prognostic significance of AP-2α/γ targets as cancer therapeutics.Scientific reports · 2022Article
- Construction and validation of a novel gene signature for predicting the prognosis of osteosarcoma.Scientific reports · 2022Article
- Perspectives on the diagnostic, predictive and prognostic markers of neuroendocrine neoplasms (Review).Experimental and therapeutic medicine · 2021Review
- Review
- Role of Endoscopic Ultrasound in the Diagnosis of Pancreatic Neuroendocrine Neoplasms.Diagnostics (Basel, Switzerland) · 2021Review
- Characteristics, Treatment, Outcomes, and Survival in Neuroendocrine G1 and G2 Pancreatic Tumors: Experiences From a Single Tertiary Referral Center.Frontiers in endocrinology · 2021Article
- Alternative Lengthening of Telomeres and Differential Expression of Endocrine Transcription Factors Distinguish Metastatic and Non-metastatic Insulinomas.Endocrine pathology · 2020Article
- Assessment of ARX expression, a novel biomarker for metastatic risk in pancreatic neuroendocrine tumors, in endoscopic ultrasound fine-needle aspiration.Diagnostic cytopathology · 2020Article
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundThe transcription factors ARX and PDX1, and alternative lengthening of telomeres (ALT) were recently described as prognostic markers for resected non-functional pancreatic neuroendocrine tumors (PanNETs). ALT positive tumors with ARX expression relapse most often. Currently, tumor size is the only preoperative marker used to decide whether or not to operate, thus additional preoperative prognostic markers are needed. Therefore, it is critical to assess the performance of these biomarkers on preoperative cytologic specimens.
methodsEndoscopic fine-needle aspiration cellblock material and corresponding surgical specimens of 13 patients with PanNETs were assessed for histology, immunohistochemical staining of ARX, PDX1, Synaptophysin, Ki67, and telomere-specific fluorescence in situ hybridization to detect ALT, and then associated with clinicopathological features. Scoring for ARX and PDX1 was performed blinded by two independent observers.
resultsOf the 13 surgical specimens, 8 were ARX+/PDX1-, 2 ARX-/PDX1+, and 3 ARX+/PDX1+. Concordance between cytologic and surgical specimens for ARX protein expression was 100%, whereas concordance for PDX1, ALT, and WHO tumor grade was 85%, 91%, and 73%, respectively. There was a perfect inter-observer agreement in ARX and PDX1 scoring.
conclusionARX can reliably be determined in cytologic specimens and has low inter-observer variability. For cytology, false-positive PDX1 expression was observed, possibly due to contamination or sampling, while ALT had a false-negative case due to incomplete sampling. As previously observed, tumor grade is underestimated in cytologic specimens. Thus, ARX and ALT are the most promising markers to predict metastatic behavior in PanNETs, thereby warranting further validation in larger studies.
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