Recently, mostly in the oncology literature, patients with Ki67 ≥ 10% are increasingly being viewed as the group that warrant further attention, close follow-up, and consideration for somatostatin analog (SSA)/peptide receptor radionuclide therapy (PRRT) and/or even conventional chemotherapy.24–35 Although this management approach is mostly based on the Ki67 index on metastatic tumors, it also is being considered for resected PanNETs, yet the literature supporting this approach from pathology perspective is limited.36 This evidence concerns the gene MKI67 and metastatic neoplasm.