ObjectiveTo explore the differences of clinical classification and pathological staging in insulinomas under different pathological classification standards, and its relationship with the clinicopathological features and prognosis. MethodsHE staining was used to detect insulinomas tissue which was previously diagnosed according to《WHO classification of digestive neuroendocrine neoplasms》(2010) and《China gastrointestinal pancreatic neuroendocrine tumor pathological diagnosis consensus》（2011）（2013), and the expression of insulin,CgA,Syn and Ki-67 were detected by immunohistochemistry , and then diagnosis was performed by different pathological classification standards, and was compared to previously diagnosed. ResultsA total of 27 insulinomas tissue samples were collected. When cut-off levels of 2% and 20% for Ki-67, 16 cases were diagnosed as grade 1 of NET, grade 2 of NET was 9 cases and 2 patients was NEC; when cut-off levels of 5% and 20% for Ki-67, the patients diagnosed as grade 1 of NET, grade 2 of NET and NEC were 21, 4, 0, respectively, and 2 cases were high proliferation activity of NET. The positive expression rate of insulin, CgA, Syn in insulinomas was 66.67%, 74.07%, 100%, respectively. The histologic categories were correlated with tumor size, course of disease (χ2=8.834、32.693，P=0.026、0.008), and had no correlation with tumor distant metastasis, local invasion, gender, age, nationality, ABO blood group (χ2=5.83、5.83、4.079、43.153、0.484、3.536，P＞0.05）. Kaplan-Meier survival curves showed that there was no significant difference in survival between grade 1 of NET group and grade 2 of NET group (P＞0.05). ConclusionThere is difference of the two pathological grading schemes in diagnosing insulinoma. “High proliferative activity of NET” advanced by China can solve the problems of naming and classification for non-poorly differentiated tumors with Ki-67 index 20% to 60%.

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