Comparison of 3 Ways of Dissecting the Pancreatoduodenectomy Specimen and Their Impact in the Lymph Node Count and the Lymph Node Metastatic Ratio

Lino-Silva, Leonardo S.; Salcedo‐Hernández, Rosa A.; Segales-Rojas, Patricia; Zepeda-Najar, César

doi:10.1177/1066896918780343

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Diverse opinions exist whether perpendicular sectioning of uncinate/SMA and posterior surface/margin leads to inaccurate or an overestimation of total lymph node count. A recent comparison study of all 3 grossing protocols showed that the bivalve protocol yielded more lymph node count and lymph node metastasis than the other 2 grossing protocols, supporting that different grossing protocols can affect lymph node yield 45. However, both axial and bivalve protocols require perpendicular sectioning of uncinate/SMA and posterior surface/margins.…”

Section: Discussionmentioning

confidence: 99%

“…A recent comparison study of all 3 grossing protocols showed that the bivalve protocol yielded more lymph node count and lymph node metastasis than the other 2 grossing protocols, supporting that different grossing protocols can affect lymph node yield. 45 However, both axial and bivalve protocols require perpendicular sectioning of uncinate/SMA and posterior surface/margins. Therefore, this controversial result does not necessarily support one or the other grossing protocol.…”

Section: Interpretations Of Pt4 Categorymentioning

confidence: 99%

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Towards a More Standardized Approach to Pathologic Reporting of Pancreatoduodenectomy Specimens for Pancreatic Ductal Adenocarcinoma

Dhall

Shi

Allende

et al. 2021

American Journal of Surgical Pathology

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In recent literature and international meetings held, it has become clear that there are significant differences regarding the definition of what constitutes as margins and how best to document the pathologic findings in pancreatic ductal adenocarcinoma. To capture the current practice, Pancreatobiliary Pathology Society (PBPS) Grossing Working Group conducted an international multispecialty survey encompassing 25 statements, regarding pathologic examination and reporting of pancreatic ductal adenocarcinoma, particularly in pancreatoduodenectomy specimens. The survey results highlighted several discordances; however, consensus/high concordance was reached for the following: (1) the pancreatic neck margin should be entirely submitted en face, and if tumor on the slide, then it is considered equivalent to R1; (2) uncinate margin should be submitted entirely and perpendicularly sectioned, and tumor distance from the uncinate margin should be reported; (3) all other surfaces (including vascular groove, posterior surface, and anterior surface) should be examined and documented; (4) carcinoma involving separately submitted celiac axis specimen should be staged as pT4. Although no consensus was achieved regarding what constitutes R1 versus R0, most participants agreed that ink on tumor or at and within 1 mm to the tumor is equivalent to R1 only in areas designated as a margin, not surface. In conclusion, this survey raises the awareness of the discordances and serves as a starting point towards further standardization of the pancreatoduodenectomy grossing and reporting protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Interpretations Of Pt4 Categorymentioning

confidence: 99%

Towards a More Standardized Approach to Pathologic Reporting of Pancreatoduodenectomy Specimens for Pancreatic Ductal Adenocarcinoma

Dhall

Shi

Allende

et al. 2021

American Journal of Surgical Pathology

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“…This method is beneficial, especially in evaluating intraductal lesions such as intraductal papillary mucinous neoplasms and ampullary tumors and does not require entire submission of the pancreas. In a recent comparative study, it was also found to be associated with a better lymph node yield and lymph node ratio [22]. However, R1 rate is reportedly lower in specimens grossed by the bivalving method, and inadequate sampling of the margins and free surfaces was thought to be the reason for the low R1 rate [15].…”

Section: Grossing Protocols and R0/r1 Statusmentioning

confidence: 99%

Whipple Grossing in the Era of New Staging: Should We Standardize?

Shi

Baştürk

2019

Diagnostics

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Whipple procedure, also known as pancreatoduodenectomy, is the most common surgery for the removal of tumors of the head of the pancreas, ampulla, distal common bile duct, or periampullary duodenum. It is also one of the most challenging resection specimens grossed by surgical pathologists. A thorough and consistent evaluation of the gross surgical specimen is the most critical first step for accurate diagnosis, determination of tumor origin, staging, and evaluation of margin status. However, there has been no standard grossing protocol for Whipple specimens, which has led to inaccurate diagnoses, staging, and inconsistent reporting. This issue has become even more challenging in the era of the size-based tumor staging systems recommended by the new 8th Edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual. Moreover, new concerns have been raised regarding how to best evaluate margin status and lymph nodes. Studies have shown that different Whipple grossing methods can significantly impact margin assessment and lymph node yield and thus affect R0/R1 status and clinical stage. Other important issues under debate include nomenclature, definitions of margin (versus surface), and R1 status. Consistent Whipple grossing and standardization of reporting will provide better communication and more accurate diagnosis and staging, as well as prognostic prediction.

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Is the Involvement of the Hepatic Artery Lymph Node a Poor Prognostic Factor in Pancreatic Adenocarcinoma?

Rodrigues

Dopazo

Pando

et al. 2020

Cirugía Española (English Edition)

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Comparison of 3 Ways of Dissecting the Pancreatoduodenectomy Specimen and Their Impact in the Lymph Node Count and the Lymph Node Metastatic Ratio

Abstract: The Adsay technique for LN retrieval was associated with a better LN count, more cases with LNM, and an LNR >0.1.

Cited by 6 publications

References 24 publications

Towards a More Standardized Approach to Pathologic Reporting of Pancreatoduodenectomy Specimens for Pancreatic Ductal Adenocarcinoma

Towards a More Standardized Approach to Pathologic Reporting of Pancreatoduodenectomy Specimens for Pancreatic Ductal Adenocarcinoma

Whipple Grossing in the Era of New Staging: Should We Standardize?

Is the Involvement of the Hepatic Artery Lymph Node a Poor Prognostic Factor in Pancreatic Adenocarcinoma?

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