Pathologic Examination of Pancreatic Specimens Resected for Treated Pancreatic Ductal Adenocarcinoma Recommendations From the Pancreatobiliary Pathology Society

• Type of Material: Article
• Authors: Huamin Wang, The University of Texas M.D. Anderson Cancer Center; Runjan Chetty, Brighton & Sussex University Hospitals; Mojgan Hosseini, University of California San Diego; Daniela S Allende, Cleveland Clinic; Irene Esposito, University Hospital of Duesseldorf; Yoko Matsuda, Kagawa University; Vikram Deshpande, Harvard Medical School; Jiaqi Shi, University of Michigan; Deepti Dhall, University of Alabama Birmingham; Kee-Taek Jang, Sungkyunkwan University; Grace E Kim, University of California San Francisco; Claudio Luchini, University and Hospital Trust of Verona; Rondell P Graham, Mayo Clinic, Rochester; Michelle Reid, Emory University; Olca Basturk, Memorial Sloan Kettering Cancer Center; Ralph H Hruban, Johns Hopkins University; Alyssa Krasinskas, Emory University; David S Klimstra, Memorial Sloan Kettering Cancer Center; Volkan Adsay, Koc University Hospital and KUTTAM Research Center
• Language: English
• Date: 2022-06-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/PAS.0000000000001853
• Title of Journal or Parent Work: AMERICAN JOURNAL OF SURGICAL PATHOLOGY
• Volume: 46
• Issue: 6
• Start Page: 754
• End Page: 764
• Grant/Funding Information: HW: The National Institutes of Health grants (1R01CA196941, 1R01CA195651, U01CA196403, P01CA117969, and P50CA221707); JS: The National Institutes of Health grant (K08CA234222)
• Keywords: BREAST; gross examination; pancreatic ductal adenocarcinoma; NUMBER; survival; SURVIVAL; neoadjuvant therapy; Surgery; mapping sections; Life Sciences & Biomedicine; POSTTHERAPY PANCREATICODUODENECTOMY; tumor size; lymph node metastasis; tumor response grade; CHEMOTHERAPY; PREDICTS POOR-PROGNOSIS; STAGING SYSTEM; NEOADJUVANT THERAPY; Science & Technology; INVASION; Pathology; CANCER

Abstract

Currently, there are no internationally accepted consensus guidelines for pathologic evaluation of posttherapy pancreatectomy specimens. The Neoadjuvant Therapy Working Group of Pancreatobiliary Pathology Society was formed in 2018 to review grossing protocols, literature, and major issues and to develop recommendations for pathologic evaluation of posttherapy pancreatectomy specimens. The working group generated the following recommendations: (1) Systematic and standardized grossing and sampling protocols should be adopted for pancreatectomy specimens for treated pancreatic ductal adenocarcinoma (PDAC). (2) Consecutive mapping sections along the largest gross tumor dimension are recommended to validate tumor size by histology as required by the College of American Pathologists (CAP) cancer protocol. (3) Tumor size of treated PDACs should be measured microscopically as the largest dimension of tumor outer limits that is bound by viable tumor cells, including intervening stroma. (4) The MD Anderson grading system for tumor response has a better correlation with prognosis and better interobserver concordance among pathologists than does the CAP system. (5) A case should not be classified as a complete response unless the entire pancreas, peripancreatic tissues, ampulla of Vater, common bile duct, and duodenum adjacent to the pancreas are submitted for microscopic examination. (6) Future studies on tumor response of lymph node metastases, molecular and/or immunohistochemical markers, as well as application of artificial intelligence in grading tumor response of treated PDAC are needed. In summary, systematic, standardized pathologic evaluation, accurate tumor size measurement, and reproducible tumor response grading to neoadjuvant therapy are needed for optimal patient care. The criteria and discussions provided here may provide guidance towards these goals.