{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:48:59Z","timestamp":1791571739053,"version":"4.3.4"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Endocr Pathol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The aim of this study was to assess whether there is sufficient evidence to recommend a change in the classification of pulmonary tumors currently classified as \u201ccarcinoid\u201d tumors to instead apply a system similar to that used for well-differentiated gastrointestinal and pancreatic neuroendocrine tumors (NETs) using the Ki67 proliferation index (PI). We retrospectively reviewed 124 cases of pulmonary NETs (\u201ctypical carcinoids\u201d (TC) and \u201catypical carcinoids\u201d (AC)) diagnosed at the University Hospitals Cleveland Medical Center between 2019 and 2025. Demographic, clinical, and pathology data were collected, including mitotic counts, necrosis, and Ki67 PI assessed in biopsy, resection, and metastatic specimens. Tumors were graded as G1 (\u2264\u20093%), G2 (3\u201320%), and G3 (&gt;\u200920%) according to the 5th edition WHO criteria for gastroenteropancreatic NETs. Grading based on Ki67 PI was significantly associated with lymphatic invasion (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007), lymph node metastasis (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.016), liver metastasis (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.047), AJCC stage at diagnosis (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and patient mortality (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.047). This approach provided better correlation than necrosis for liver metastasis and mortality, better than mitoses for all negative outcomes than other than liver metastasis, and better than TC\/AC classification for mortality. Tumors classified as G3 had significantly worse patient outcomes than those classified as G1 or G2. Incorporating Ki67 PI into the classification provides clinically important information regarding tumor progression, staging, and survival. These findings support the adoption of a three-tiered Ki67-based grading system (G1\u2013G3) for pulmonary NETs, \u200b\u200bsimilar to gastroenteropancreatic NETs.\n                  <\/jats:p>","DOI":"10.1007\/s12022-026-09914-2","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T07:13:20Z","timestamp":1775027600000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Well-Differentiated Neuroendocrine Tumors of Lung: A Case Series Supporting the IARC\/WHO Common Classification of Neuroendocrine Tumor Nomenclature and Grading"],"prefix":"10.1007","volume":"37","author":[{"given":"Eren","family":"Altun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2589-3936","authenticated-orcid":false,"given":"Omid","family":"Savari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0762-7239","authenticated-orcid":false,"given":"Mart Andrew","family":"Maravillas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8418-5054","authenticated-orcid":false,"given":"Sylvia L.","family":"Asa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"9914_CR1","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.jtho.2021.11.003","volume":"17","author":"AG Nicholson","year":"2022","unstructured":"Nicholson AG, Tsao MS, Beasley MB, Borczuk AC, Brambilla E, Cooper WA, Dacic S, Jain D, Kerr KM, Lantuejoul S, Noguchi M, Papotti M, Rekhtman N, Scagliotti G, van SP, Sholl L, Yatabe Y, Yoshida A, Travis WD: The 2021 WHO Classification of Lung Tumors: Impact of Advances Since 2015. J Thorac Oncol 2022, 17:362\u2013387.","journal-title":"J Thorac Oncol"},{"key":"9914_CR2","doi-asserted-by":"publisher","first-page":"e13412","DOI":"10.1111\/jne.13412","volume":"36","author":"A Koumarianou","year":"2024","unstructured":"Koumarianou A, Filosso PL, Bodei L, Castano JP, Fernandez-Cuesta L, Deroose CM, Foll M, Dromain C, Reed NS, Caplin M, Capdevila J, Falkerby J, Faggiano A, Frilling A, Grande E, Hicks RJ, Kasajima A, Kos-Kudla B, Krishna BA, Lim E, Rinke A, Singh S, Thirlwell C, Volante M, Walter T: Clinical management of typical and atypical carcinoids\/neuroendocrine tumors in ENETS centres of excellence (CoE): Survey from the ENETS lung NET task force. J Neuroendocrinol 2024, 36:e13412.","journal-title":"J Neuroendocrinol"},{"key":"9914_CR3","doi-asserted-by":"crossref","unstructured":"Pelosi G, Laffi A, Catalano G, Bruno A, Papotti M, Bassani B, Bianchi F, Duregon E, De Pas TM, Catania C, Ricotta R, Papa R, Harari S, Sonzogni A, Guerriero I, Ambrosino C, Pane K, Franzese M, Gemelli M: Pathology, molecular biology, medical oncology, and radiotherapy implications of lung neuroendocrine neoplasm classification: a multidisciplinary perspective. Expert Rev Anticancer Ther 2025:1\u201337.","DOI":"10.1080\/14737140.2025.2584486"},{"key":"9914_CR4","doi-asserted-by":"crossref","unstructured":"Vocino TG, Volante M: Changes in categorization or nomenclature within neuroendocrine tumors. Endocr Relat Cancer 2024, 31.","DOI":"10.1530\/ERC-24-0004"},{"key":"9914_CR5","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1007\/s12094-017-1759-2","volume":"20","author":"O Abdel-Rahman","year":"2018","unstructured":"Abdel-Rahman O: Modified staging system for pulmonary carcinoids on the basis of lung cancer TNM system. Clin Transl Oncol 2018, 20:670\u2013677.","journal-title":"Clin Transl Oncol"},{"key":"9914_CR6","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.21037\/jtd-23-1681","volume":"16","author":"M Spils","year":"2024","unstructured":"Spils M, Klikovits T, Krenbek D, Hochmair MJ, Jankovic I, Schulte L, Krajc T, Benej M, Getman V, Navarrete JR, Akan A, Mueller MR, Aigner C, Watzka SB: Prognostic factors of recurrence and disease-free survival in radically resected pulmonary carcinoids: a real-world analysis. J Thorac Dis 2024, 16:1911\u20131922.","journal-title":"J Thorac Dis"},{"key":"9914_CR7","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1038\/s41379-018-0110-y","volume":"31","author":"G Rindi","year":"2018","unstructured":"Rindi G, Klimstra DS, Abedi-Ardekani B, Asa SL, Bosman FT, Brambilla E, Busam KJ, de Krijger RR, Dietel M, El-Naggar AK, Fernandez-Cuesta L, Kloppel G, McCluggage WG, Moch H, Ohgaki H, Rakha EA, Reed NS, Rous BA, Sasano H, Scarpa A, Scoazec JY, Travis WD, Tallini G, Trouillas J, van Krieken JH, Cree IA: A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) expert consensus proposal. Mod Pathol 2018, 31:1770\u20131786.","journal-title":"Mod Pathol"},{"key":"9914_CR8","doi-asserted-by":"publisher","first-page":"377","DOI":"10.32074\/1591-951X-542","volume":"113","author":"G Pelosi","year":"2021","unstructured":"Pelosi G, Travis WD: The Ki-67 antigen in the new 2021 World Health Organization classification of lung neuroendocrine neoplasms. Pathologica 2021, 113:377\u2013387.","journal-title":"Pathologica"},{"key":"9914_CR9","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3389\/fendo.2011.00020","volume":"2","author":"F Grimaldi","year":"2011","unstructured":"Grimaldi F, Muser D, Beltrami CA, Machin P, Morelli A, Pizzolitto S, Talmassons G, Marciello F, Colao AA, Monaco R, Monaco G, Faggiano A: Partitioning of bronchopulmonary carcinoids in two different prognostic categories by ki-67 score. Front Endocrinol (Lausanne) 2011, 2:20.","journal-title":"Front Endocrinol (Lausanne)"},{"key":"9914_CR10","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1038\/modpathol.2012.81","volume":"25","author":"AE Walts","year":"2012","unstructured":"Walts AE, Ines D, Marchevsky AM: Limited role of Ki-67 proliferative index in predicting overall short-term survival in patients with typical and atypical pulmonary carcinoid tumors. Mod Pathol 2012, 25:1258\u20131264.","journal-title":"Mod Pathol"},{"key":"9914_CR11","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s00428-012-1194-2","volume":"460","author":"T Zahel","year":"2012","unstructured":"Zahel T, Krysa S, Herpel E, Stenzinger A, Goeppert B, Schirmacher P, Hoffmann H, Schnabel PA, Warth A: Phenotyping of pulmonary carcinoids and a Ki-67-based grading approach. Virchows Arch 2012, 460:299\u2013308.","journal-title":"Virchows Arch"},{"key":"9914_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1530\/ERC-13-0246","volume":"21","author":"G Rindi","year":"2014","unstructured":"Rindi G, Klersy C, Inzani F, Fellegara G, Ampollini L, Ardizzoni A, Campanini N, Carbognani P, De Pas TM, Galetta D, Granone PL, Righi L, Rusca M, Spaggiari L, Tiseo M, Viale G, Volante M, Papotti M, Pelosi G: Grading the neuroendocrine tumors of the lung: an evidence-based proposal. Endocr Relat Cancer 2014, 21:1\u201316.","journal-title":"Endocr Relat Cancer"},{"key":"9914_CR13","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1097\/PAS.0000000000000300","volume":"38","author":"DR Swarts","year":"2014","unstructured":"Swarts DR, van Suylen RJ, den Bakker MA, van Oosterhout MF, Thunnissen FB, Volante M, Dingemans AM, Scheltinga MR, Bootsma GP, Pouwels HM, van den Borne BE, Ramaekers FC, Speel EJ: Interobserver variability for the WHO classification of pulmonary carcinoids. Am J Surg Pathol 2014, 38:1429\u20131436.","journal-title":"Am J Surg Pathol"},{"key":"9914_CR14","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s12094-016-1568-z","volume":"19","author":"V Clay","year":"2017","unstructured":"Clay V, Papaxoinis G, Sanderson B, Valle JW, Howell M, Lamarca A, Krysiak P, Bishop P, Nonaka D, Mansoor W: Evaluation of diagnostic and prognostic significance of Ki-67 index in pulmonary carcinoid tumours. Clin Transl Oncol 2017, 19:579\u2013586.","journal-title":"Clin Transl Oncol"},{"key":"9914_CR15","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1111\/his.13096","volume":"70","author":"DR Swarts","year":"2017","unstructured":"Swarts DR, Rudelius M, Claessen SM, Cleutjens JP, Seidl S, Volante M, Ramaekers FC, Speel EJ: Limited additive value of the Ki-67 proliferative index on patient survival in World Health Organization-classified pulmonary carcinoids. Histopathology 2017, 70:412\u2013422.","journal-title":"Histopathology"},{"key":"9914_CR16","doi-asserted-by":"crossref","unstructured":"de Vilhena AF, das Neves Pereira JC, Parra ER, Balancin ML, Ab SA, Martins V, Farhat C, Abrantes MM, de Campos JRM, Tedde ML, Takagaki T, Capelozzi VL: Histomorphometric evaluation of the Ki-67 proliferation rate and CD34 microvascular and D2-40 lymphovascular densities drives the pulmonary typical carcinoid outcome. Hum Pathol 2018, 81:201\u2013210.","DOI":"10.1016\/j.humpath.2018.07.007"},{"key":"9914_CR17","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1038\/s41379-018-0076-9","volume":"31","author":"AM Marchevsky","year":"2018","unstructured":"Marchevsky AM, Hendifar A, Walts AE: The use of Ki-67 labeling index to grade pulmonary well-differentiated neuroendocrine neoplasms: current best evidence. Mod Pathol 2018, 31:1523\u20131531.","journal-title":"Mod Pathol"},{"key":"9914_CR18","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1080\/0284186X.2018.1441543","volume":"57","author":"T Vesterinen","year":"2018","unstructured":"Vesterinen T, Mononen S, Salmenkivi K, Mustonen H, Rasanen J, Salo JA, Ilonen I, Knuuttila A, Haglund C, Arola J: Clinicopathological indicators of survival among patients with pulmonary carcinoid tumor. Acta Oncol 2018, 57:1109\u20131116.","journal-title":"Acta Oncol"},{"key":"9914_CR19","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1159\/000495806","volume":"108","author":"A Kasajima","year":"2019","unstructured":"Kasajima A, Konukiewitz B, Oka N, Suzuki H, Sakurada A, Okada Y, Kameya T, Ishikawa Y, Sasano H, Weichert W, Kloppel G: Clinicopathological Profiling of Lung Carcinoids with a Ki67 Index\u2009>\u200920. Neuroendocrinology 2019, 108:109\u2013120.","journal-title":"Neuroendocrinology"},{"key":"9914_CR20","doi-asserted-by":"publisher","first-page":"e031531","DOI":"10.1136\/bmjopen-2019-031531","volume":"9","author":"S Naheed","year":"2019","unstructured":"Naheed S, Holden C, Tanno L, Jaynes E, Cave J, Ottensmeier CH, Pelosi G: The utility of Ki-67 as a prognostic biomarker in pulmonary neuroendocrine tumours: protocol for a systematic review and meta-analysis. BMJ Open 2019, 9:e031531.","journal-title":"BMJ Open"},{"key":"9914_CR21","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/PAS.0000000000001358","volume":"44","author":"JKT Dermawan","year":"2020","unstructured":"Dermawan JKT, Farver CF: The Role of Histologic Grading and Ki-67 Index in Predicting Outcomes in Pulmonary Carcinoid Tumors. Am J Surg Pathol 2020, 44:224\u2013231.","journal-title":"Am J Surg Pathol"},{"key":"9914_CR22","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1159\/000502776","volume":"110","author":"N Oka","year":"2020","unstructured":"Oka N, Kasajima A, Konukiewitz B, Sakurada A, Okada Y, Kameya T, Weichert W, Ishikawa Y, Suzuki H, Sasano H, Kloppel G: Classification and Prognostic Stratification of Bronchopulmonary Neuroendocrine Neoplasms. Neuroendocrinology 2020, 110:393\u2013403.","journal-title":"Neuroendocrinology"},{"key":"9914_CR23","doi-asserted-by":"publisher","first-page":"274","DOI":"10.4103\/atm.atm_599_20","volume":"16","author":"AK Patane","year":"2021","unstructured":"Patane AK, Guma G, Raya M, Rosales A, Astorino W, Rosenberg M: Pulmonary neuroendocrine carcinoid tumors: Is there a predictive role to the Ki 67 index? Ann Thorac Med 2021, 16:274\u2013279.","journal-title":"Ann Thorac Med"},{"key":"9914_CR24","doi-asserted-by":"publisher","first-page":"e13180","DOI":"10.1111\/jne.13180","volume":"34","author":"L Spurgeon","year":"2022","unstructured":"Spurgeon L, Jones J, Lewis A, Rammohan K, Shaheen F, Weaver J, Papaxoinis G, Mansoor W: The occurrence and associated risk factors of brain metastases in well differentiated grade 1 and 2 bronchial neuroendocrine tumours: A single centre retrospective analysis of 280 patients. J Neuroendocrinol 2022, 34:e13180.","journal-title":"J Neuroendocrinol"},{"key":"9914_CR25","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/his.14819","volume":"82","author":"G Centonze","year":"2023","unstructured":"Centonze G, Maisonneuve P, Simbolo M, Lagano V, Grillo F, Fabbri A, Prinzi N, Garzone G, Filugelli M, Pardo C, Mietta A, Pusceddu S, Sabella G, Bercich L, Mangogna A, Rolli L, Grisanti S, Benvenuti MR, Pastorino U, Roz L, Scarpa A, Berruti A, Capella C, Milione M: Lung carcinoid tumours: histology and Ki-67, the eternal rivalry. Histopathology 2023, 82:324\u2013339.","journal-title":"Histopathology"},{"key":"9914_CR26","doi-asserted-by":"publisher","first-page":"103591","DOI":"10.1016\/j.esmoop.2024.103591","volume":"9","author":"E Mathian","year":"2024","unstructured":"Mathian E, Drouet Y, Sexton-Oates A, Papotti MG, Pelosi G, Vignaud JM, Brcic L, Mansuet-Lupo A, Damiola F, Altun C, Berthet JP, Fournier CB, Brustugun OT, Centonze G, Chalabreysse L, de Montpreville VT, di Micco CM, Fadel E, Gadot N, Graziano P, Hofman P, Hofman V, Lacomme S, Lund-Iversen M, Mangiante L, Milione M, Muscarella LA, Perrin C, Planchard G, Popper H, Rousseau N, Roz L, Sabella G, Tabone-Eglinger S, Voegele C, Volante M, Walter T, Dingemans AM, Moonen L, Speel EJ, Derks J, Girard N, Chen L, Alcala N, Fernandez-Cuesta L, Lantuejoul S, Foll M: Assessment of the current and emerging criteria for the histopathological classification of lung neuroendocrine tumours in the lungNENomics project. ESMO Open 2024, 9:103591.","journal-title":"ESMO Open"},{"key":"9914_CR27","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1097\/PAS.0000000000002227","volume":"48","author":"JR Naso","year":"2024","unstructured":"Naso JR, Jenkins SM, Roden AC, Yi ES, Lo YC, Bois MC, Maleszewski JJ, Aubry MC, Boland JM: Prognostic Immunohistochemistry for Ki-67 and OTP on Small Biopsies of Pulmonary Carcinoid Tumors: Ki-67 Index Predicts Progression-free Survival and Atypical Histology. Am J Surg Pathol 2024, 48:742\u2013750.","journal-title":"Am J Surg Pathol"},{"key":"9914_CR28","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s12022-025-09882-z","volume":"36","author":"A Ura","year":"2025","unstructured":"Ura A, Evert K, Evert M, Markl B, Kremer M, Moser E, Sasano H, Okada Y, Steiger K, Mogler C, Jesinghaus M, von WA, Safi S, Hoffmann H, Kloppel G, Kasajima A: Phenotypic Landscape of Pulmonary Neuroendocrine Tumors: Subtyped by OTP\/ASCL1 Expression Correlated with Histology, Hormones and Outcome. Endocr Pathol 2025, 36:43.","journal-title":"Endocr Pathol"},{"key":"9914_CR29","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/s12022-021-09668-z","volume":"32","author":"M Volante","year":"2021","unstructured":"Volante M, Mete O, Pelosi G, Roden AC, Speel EJM, Uccella S: Molecular Pathology of Well-Differentiated Pulmonary and Thymic Neuroendocrine Tumors: What Do Pathologists Need to Know? Endocr Pathol 2021, 32:154\u2013168.","journal-title":"Endocr Pathol"},{"key":"9914_CR30","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1007\/s00428-017-2177-0","volume":"471","author":"C Marchio","year":"2017","unstructured":"Marchio C, Gatti G, Massa F, Bertero L, Filosso P, Pelosi G, Cassoni P, Volante M, Papotti M: Distinctive pathological and clinical features of lung carcinoids with high proliferation index. Virchows Arch 2017, 471:713\u2013720.","journal-title":"Virchows Arch"},{"key":"9914_CR31","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1038\/s41379-019-0248-2","volume":"32","author":"N Rekhtman","year":"2019","unstructured":"Rekhtman N, Desmeules P, Litvak AM, Pietanza MC, Santos-Zabala ML, Ni A, Montecalvo J, Chang JC, Beras A, Preeshagul IR, Sabari JK, Rudin CM, Ladanyi M, Klimstra DS, Travis WD, Lai WC: Stage IV lung carcinoids: spectrum and evolution of proliferation rate, focusing on variants with elevated proliferation indices. Mod Pathol 2019, 32:1106\u20131122.","journal-title":"Mod Pathol"},{"key":"9914_CR32","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1038\/s41379-021-00820-y","volume":"34","author":"SL Asa","year":"2021","unstructured":"Asa SL, Mete O, Cusimano MD, McCutcheon IE, Perry A, Yamada S, Nishioka H, Casar-Borota O, Uccella S, La Rosa S, Grossman AB, Ezzat S: Pituitary neuroendocrine tumors: a model for neuroendocrine tumor classification. Mod Pathol 2021, 34:1634\u20131650.","journal-title":"Mod Pathol"},{"key":"9914_CR33","doi-asserted-by":"crossref","unstructured":"Slott C, Langer SW, Moller S, Krogh J, Klose M, Hansen CP, Kjaer A, Holmager P, Garbyal RS, Knigge U, Andreassen M: Outlook for 615 Small Intestinal Neuroendocrine Tumor Patients: Recurrence Risk after Surgery and Disease-Specific Survival in Advanced Disease. Cancers (Basel) 2024, 16.","DOI":"10.3390\/cancers16010204"},{"key":"9914_CR34","doi-asserted-by":"publisher","first-page":"102299","DOI":"10.1016\/j.ctrv.2021.102299","volume":"101","author":"R Broadbent","year":"2021","unstructured":"Broadbent R, Wheatley R, Stajer S, Jacobs T, Lamarca A, Hubner RA, Valle JW, Amir E, McNamara MG: Prognostic factors for relapse in resected gastroenteropancreatic neuroendocrine neoplasms: A systematic review and meta-analysis. Cancer Treat Rev 2021, 101:102299.","journal-title":"Cancer Treat Rev"},{"key":"9914_CR35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.4103\/jpi.jpi_76_18","volume":"10","author":"Z Volynskaya","year":"2019","unstructured":"Volynskaya Z, Mete O, Pakbaz S, Al-Ghamdi D, Asa SL: Ki67 quantitative interpretation: Insights using image analysis. J Pathol Inform 2019.","journal-title":"J Pathol Inform"},{"key":"9914_CR36","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s12022-021-09701-1","volume":"33","author":"IA Cree","year":"2022","unstructured":"Cree IA: From Counting Mitoses to Ki67 Assessment: Technical Pitfalls in the New WHO Classification of Endocrine and Neuroendocrine Tumors. Endocr Pathol 2022, 33:3\u20135.","journal-title":"Endocr Pathol"},{"key":"9914_CR37","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.1158\/1078-0432.CCR-15-2946","volume":"22","author":"N Rekhtman","year":"2016","unstructured":"Rekhtman N, Pietanza MC, Hellmann MD, Naidoo J, Arora A, Won H, Halpenny DF, Wang H, Tian SK, Litvak AM, Paik PK, Drilon AE, Socci N, Poirier JT, Shen R, Berger MF, Moreira AL, Travis WD, Rudin CM, Ladanyi M: Next-Generation Sequencing of Pulmonary Large Cell Neuroendocrine Carcinoma Reveals Small Cell Carcinoma-like and Non-Small Cell Carcinoma-like Subsets. Clin Cancer Res 2016, 22:3618\u20133629.","journal-title":"Clin Cancer Res"},{"key":"9914_CR38","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1111\/pin.13266","volume":"72","author":"A Kasajima","year":"2022","unstructured":"Kasajima A, Kloppel G: Neuroendocrine tumor G3 of bronchopulmonary origin and its classification. Pathol Int 2022, 72:488\u2013495.","journal-title":"Pathol Int"},{"key":"9914_CR39","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1097\/PAS.0b013e3182819f0f","volume":"37","author":"SH Lee","year":"2013","unstructured":"Lee SH, Kim BC, Chang HJ, Sohn DK, Han KS, Hong CW, Lee EJ, Lee JB, Lee DS, Lee IT, Youk EG: Rectal neuroendocrine and L-cell tumors: diagnostic dilemma and therapeutic strategy. Am J Surg Pathol 2013, 37:1044\u20131052.","journal-title":"Am J Surg Pathol"},{"key":"9914_CR40","doi-asserted-by":"publisher","first-page":"813","DOI":"10.4143\/crt.2014.238","volume":"47","author":"JH Sohn","year":"2015","unstructured":"Sohn JH, Cho MY, Park Y, Kim H, Kim WH, Kim JM, Jung ES, Kim KM, Lee JH, Chan HK, Park DY, Joo M, Kim S, Moon WS, Kang MS, Jin SY, Kang YK, Yoon SO, Han H, Choi E: Prognostic Significance of Defining L-Cell Type on the Biologic Behavior of Rectal Neuroendocrine Tumors in Relation with Pathological Parameters. Cancer Res Treat 2015, 47:813\u2013822.","journal-title":"Cancer Res Treat"},{"key":"9914_CR41","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1097\/PAS.0000000000000400","volume":"39","author":"JY Kim","year":"2015","unstructured":"Kim JY, Kim KS, Kim KJ, Park IJ, Lee JL, Myung SJ, Park Y, Park YS, Yu CS, Kim JC, Yu E, Jang HJ, Hong SM: Non-L-cell immunophenotype and large tumor size in rectal neuroendocrine tumors are associated with aggressive clinical behavior and worse prognosis. Am J Surg Pathol 2015, 39:632\u2013643.","journal-title":"Am J Surg Pathol"},{"key":"9914_CR42","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s12022-024-09813-4","volume":"35","author":"O Mete","year":"2024","unstructured":"Mete O, Dodington DW, Shen DL, Asa SL: The Clinicopathological Significance of Tumor Cell Subtyping in Appendiceal Neuroendocrine Tumors: A Series of 135 Tumors. Endocr Pathol 2024, 35:107\u2013112.","journal-title":"Endocr Pathol"}],"container-title":["Endocrine Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12022-026-09914-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12022-026-09914-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12022-026-09914-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:18:11Z","timestamp":1781644691000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12022-026-09914-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["9914"],"URL":"https:\/\/doi.org\/10.1007\/s12022-026-09914-2","relation":{},"ISSN":["1046-3976","1559-0097"],"issn-type":[{"value":"1046-3976","type":"print"},{"value":"1559-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"assertion":[{"value":"22 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors consent to publication.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Dr. Sylvia L. Asa is a member of the editorial board of Endocrine Pathology.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"17"}}