This grading has direct therapeutic implications: the strongest antiproliferative evidence for somatostatin analogs is in Ki-67 ≤ 10%; by contrast, poorly differentiated neuroendocrine carcinomas (NECs, often Ki-67 > 50%) are biologically distinct and are generally managed with cytotoxic chemotherapy [18,19]. The gene discussed is MKI67; the disease is neuroendocrine carcinoma.