Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy specimens

Abstract

A pancreatoduodenectomy specimen is complex, and there is much debate on how it is best approached by the pathologist. In this review, we provide an overview of topics relevant for current clinical practice in terms of gross dissection, and macro- and microscopic assessment of the pancreatoduodenectomy specimen with a suspicion of suspected pancreatic cancer. Tumor origin, tumor size, degree of differentiation, lymph node status, and resection margin status are universally accepted as prognostic for survival. However, different guidelines diverge on important issues, such as the diagnostic criteria for evaluating the completeness of resection. The macroscopic assessment of the site of origin in periampullary tumors and cystic lesions is influenced by the grossing method. Bi-sectioning of the head of the pancreas may offer an advantage in this respect, as this method allows for optimal visualization of the periampullary area. However, a head-to-head comparison of the assessment of clinically relevant parameters, using axial slicing versus bi-sectioning, is not available yet and the gold standard to compare both techniques prospectively might be subject of debate. Further studies are required to validate the various dissection protocols used for pancreatoduodenectomy specimens and their specific value in the assessment of pathological parameters relevant for prognosis.

The diversity between curatively resected pancreatic head and body-tail cancers based on the 8th edition of AJCC staging system: a multicenter cohort study

“…Generally, one limitation in this study is that we don’t have a systematical standardization in surgical procedure and postoperative pathological examination throughout 3 centers, resulting in unstablebilty in lymph node yield, tumor size, and margin status [25, 26]. In addition, the sample size is still small in our current study.…”

Unravelling the Diagnostic Dilemma: A MicroRNA Panel of Circulating MiR-16 and MiR-877 as A Diagnostic Classifier for Distal Bile Duct Tumors

“…In addition, FNA is an invasive procedure which often requires multiple attempts to obtain evaluable specimens [12,13]. Diagnostic certainty is often achieved only after histopathological examination of the resection specimen, although even then distinguishing distal CCA from PDAC can be challenging [14,15,16]. Clinically employed tumor markers in blood, such as carbohydrate antigen 19–9 (CA19–9), show elevated expression levels in patients with distal CCA and PDAC, as well as in patients with benign disease (BD), such as choledocholithiasis and pancreatitis [13,17].…”

Conditional Survival After Resection for Pancreatic Cancer: A Population-Based Study and Prediction Model

“…Moreover, distinction between pancreatic, ampullary and distal bile duct cancer remains challenging, while these cancers carry different prognoses. 26 Tumors might be misclassified as pancreatic ductal adenocarcinoma and patients could therefore have a better survival than expected, being translated in increasing CS over time.…”

“…CA19-9 is a tumor marker that was shown to be of prognostic value but was not yet registered in a considerable proportion of the patients included in our cohort and could therefore not be considered in our analysis. 26 Fourth, it should be noted that the number of patients at risk in the CS analysis substantially decreased over time. Smaller groups obviously result in wider CIs, especially longer after surgery, which should be taken into account.…”