{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:07:17Z","timestamp":1787800037864,"version":"build-2784847793"},"reference-count":53,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Appendiceal well\u2010differentiated neuroendocrine tumours (NETs) are usually incidental and clinically benign. Several studies have reported different risk factors for nodal metastasis. The aim of this study was to investigate our appendiceal NETs (App\u2010NETs) to determine the factors associated with malignant behaviour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>For 120 App\u2010NETs, we reviewed the clinical presentation and follow\u2010up, including serum chromogranin A (CgA) levels, and compiled several microscopic variables. Pathological factors were compared with nodal status and time to biochemical recurrence (elevated serum CgA level) by the use of Cox regression. We also reviewed similar App\u2010NET data in the Surveillance, Epidemiology, and End Results (SEER) Programme. Among our 120 cases, seven patients had positive lymph nodes, and nine developed subsequent elevation of CgA levels; none developed distant metastases or died of disease. Only three patients had grade 2 NETs; none had nodal disease, and one developed an elevated CgA level. Increasing tumour size was associated with an increased risk of nodal disease [odds ratio (OR) 4.99, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0055). All seven node\u2010positive cases were \u226513\u00a0mm. Factors associated with elevated CgA levels included age (OR 1.04, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.041), pT4 disease (OR 10.22, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.033), and nodal disease (OR 24.0, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.012), but not size (OR 2.13, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.072). Of the 1492 reported App\u2010NETs in the SEER database with data on tumour size, 137 (9%) were pN1; only five of these (4%) were coded as being &lt;5\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Small (&lt;5\u00a0mm) App\u2010NETs that do not invade the serosa or mesoappendix appear to be overwhelmingly benign and low\u2010grade, requiring neither Ki67 staining nor synoptic reporting. Given their indolent behaviour, different nomenclature or staging may be more appropriate for these NETs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14369","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T07:37:48Z","timestamp":1616485068000},"page":"416-426","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Risk factors for progression of appendiceal neuroendocrine tumours: low\u2010stage tumours &lt;5\u00a0mm appear to be overwhelmingly indolent and may merit a separate designation"],"prefix":"10.1111","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9290-766X","authenticated-orcid":false,"given":"Mushal","family":"Noor","sequence":"first","affiliation":[{"name":"Department of Pathology University of Rochester Medical Center Rochester NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron R","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Rochester Medical Center Rochester NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M M","family":"Cates","sequence":"additional","affiliation":[{"name":"Department of Pathology Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5526-4220","authenticated-orcid":false,"given":"Raul S","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Pathology Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-018-0110-y"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.15.4377"},{"issue":"1","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"vii","DOI":"10.1016\/j.ecl.2010.12.005","article-title":"The epidemiology of gastroenteropancreatic neuroendocrine tumors","volume":"40","author":"Lawrence B","year":"2011","journal-title":"Endocrinol. 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