Ki-67 as a prognostic marker in mantle cell lymphoma-consensus guidelines of the pathology panel of the European MCL network

Wolfram Klapper, Eva Hoster, Olaf Determann, Ilske Oschlies, Jeroen van der Laak, Françoise Berger, Heinz Wolfram Bernd, José Cabeçadas, Elias Campo, Sergio Cogliatti, Martin Leo Hansmann, Philip M. Kluin, Roman Kodet, Yuri A. Krivolapov, Christoph Loddenkemper, Harald Stein, Peter Möller, Thomas E F Barth, Konrad Müller-Hermelink, Andreas RosenwaldGerman Ott, Stefano Pileri, Elisabeth Ralfkiaer, Grzegorz Rymkiewicz, Johan H. van Krieken, Hans Heinrich Wacker, Michael Unterhalt, Wolfgang Hiddemann, Martin Dreyling

Research output: Contribution to journalArticlepeer-review


Mantle cell lymphoma (MCL) has a heterogeneous clinical course and is mainly an aggressive B cell non-Hodgkin lymphoma; however, there are some indolent cases The Ki-67 index, defined by the percentage of Ki-67-positive lymphoma cells on histo-pathological slides, has been shown to be a very powerful prognostic biomarker. The pathology panel of the European MCL Network evaluated methods to assess the Ki-67 index including stringent counting, digital image analysis, and estimation by eyeballing. Counting of 2×500 lymphoma cells is the gold standard to assess the Ki-67 index since this value has been shown to predict survival in prospective randomized trials of the European MCL Network. Estimation by eyeballing and digital image analysis showed a poor concordance with the gold standard (concordance correlation coefficients [CCC] between 0.29 and 0.61 for eyeballing and CCC of 0.24 and 0.37 for two methods of digital image analysis, respectively). Counting a reduced number of lymphoma cells (2×100 cells) showed high interobserver agreement (CCC=0.74). Pitfalls of the Ki-67 index are discussed and guidelines and recommendations for assessing the Ki-67 index in MCL are given.

Original languageEnglish
Pages (from-to)103-111
Number of pages9
JournalJournal of Hematopathology
Issue number2
Publication statusPublished - 2009


  • Consensus guidelines
  • European MCL network
  • Ki-67
  • Mantle cell lymphoma
  • Prognostic marker

ASJC Scopus subject areas

  • Hematology
  • Pathology and Forensic Medicine
  • Histology


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