Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract Recommendations of Verona Consensus Meeting

• Type of Material: Article
• Authors: Volkan Adsay, Emory University; Mari Mino-Kenudson, Massachusetts General Hospital; Toru Furukawa, Tokyo Women’s Medical University; Olca Basturk, Memorial Sloan Kettering Cancer Center; Giuseppe Zamboni, University of Verona; Giovanni Marchegiani, Massachusetts General Hospital; Claudio Bassi, University of Verona; Roberto Salvia, University of Verona; Giuseppe Malleo, University of Verona; Salvatore Paiella, University of Verona; Christopher L. Wolfgang, Johns Hopkins University; Hanno Matthaei, University of Bonn; G. Johan Offerhaus, University Medical Center Utrecht; Mustapha Adham, Edouard Herriot Hospital, HCL; Marco J. Bruno, Erasmus University Medical Center; Michelle Reid, Emory University; Alyssa Krasinskas, Emory University; Gunter Kloeppel, Technical University of Munich; Nobuyuki Ohike, Showa University; Takuma Tajiri, Tokai University; Kee-Taek Jang, Sungkyunkwan University; Juan Carlos Roa, Pontificia Universidad Católica de Chile; Peter Allen, Memorial Sloan Kettering Cancer Center; Carlos Fernandez-del Castillo, Massachusetts General Hospital; Jin-Young Jang, Seoul National University Hospital; David S. Klimstra, Memorial Sloan Kettering Cancer Center; Ralph H. Hruban, Johns Hopkins University
• Language: English
• Date: 2016-01-01
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/SLA.0000000000001173
• Title of Journal or Parent Work: Annals of Surgery
• ISSN: 0003-4932
• Volume: 263
• Issue: 1
• Start Page: 162
• End Page: 177
• Keywords: mucinous; INVASIVE DUCTAL CARCINOMA; MARGIN STATUS; pancreas; EXTRAPANCREATIC MALIGNANCIES; Science & Technology; intraductal; FINE-NEEDLE-ASPIRATION; papillary; Surgery; CYSTIC NEOPLASMS; LYMPH-NODE METASTASIS; CLINICOPATHOLOGICAL FEATURES; LONG-TERM SURVIVAL; IMPORTANT PROGNOSTIC-FACTOR; MULTIFOCAL/MULTICENTRIC BREAST-CARCINOMA; Life Sciences & Biomedicine; neoplasm; IPMN
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤0.5, >0.5-≤1, >1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intrabiliary/cholecystic). Conclusions: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.