The College of American Pathologists (CAP) invites pathologists, oncologists, gastroenterologists, and other stakeholders to provide feedback on the draft recommendations for the evaluation of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) guideline. The incidence of GEP-NET was shown to be steadily increasing (~4-5% per year), especially in older population according to a recent publication by Lee et al.1 As the patients’ survival is directly related to their management, the treating oncologist is heavily dependent on the correct grading and staging by the pathologist. Currently, there is a lack of clarity with the scoring of Ki67 staining and the best specimens to test.
The College of American Pathologists (CAP) convened a multi-disciplinary panel of experts to provide evidence-based recommendations on the evaluation of GEP-NETs. The guideline scope begins with specimens submitted to the laboratory with confirmed diagnosis of GEP-NETs. Specimens under review will include fine needle aspirations, biopsies, surgical resections of both primary tumors, and metastases.
Guideline:
- Ten draft statements, including seven strong recommendations and three conditional recommendations, are now available for public comment from March 17 – April 7, 2025.
- The recommendations provide guidance to pathologists and oncologists on accurately grading GEP-NETs.
- They address daily practice scenarios for Ki67 grading in GEP-NETs, such as:
- When pathologists should perform Ki67 grading in GEP-NETs;
- Requirements for grading in cases of multiple primary tumors;
- Preferred Ki67 grading approach for metastatic versus primary tumor sites;
- Reporting of tumor grading for metastatic GEP-NETs;
- Acceptability of eyeball estimation of Ki67 staining for grading GEP-NETs;
- Digital automated counting as an alternative for Ki67 grading.
For More Information
- The expert panel encourages all stakeholders - including pathologists, gastroenterologists, oncologists, histotechnologists, hospital or laboratory managers, and patient advocacy group representatives - to read and comment on the draft recommendations, visit cap.org between March 17 – April 7, 2025.
- Following the open comment period, the guideline authors will consider all feedback to finalize the recommendations. The final recommendations will be formally published as a guideline.
The CAP Pathology and Laboratory Quality Center for Evidence-based Guidelines (Center) develops evidence-based guidelines related to the practice of pathology and laboratory medicine. Through this work, the CAP and its members continually improve the quality of diagnostic medicine and patient outcomes.