Pathology reporting of pancreatic cancer following neoadjuvant therapy: Challenges and uncertainties

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

“…There is clearly a need for uniformity in the handling of these specimens and at present, we would recommend that the entire pancreas or at least the macroscopic abnormal area be sampled in its entirety, although this too can be difficult to delineate by naked eye. In a recent review, a similar recommendation was made by Verbeke et al ,48 where they additionally advocate the use of whole mount blocks to accommodate full specimen slices to possibly map the tumour; however, while ideal, we concede this practice may not be possible in all laboratories.…”

Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy

“…Preliminary reports, together with some evidence suggesting that surgery may have a survival benefit compared to palliation for patients with locally advanced pancreatic cancer, motivated the scientific international community to be more open to extended resection after adequate medical treatment [2]. New data also shows that the histological regression is not necessarily reflected by radiological CT findings as fibrosis can hardly be differentiated from vital tumor on a CT scan [10, 11]. Furthermore, histological arterial invasion has been confirmed in a median of 26 % of the resected arteries, which illustrates the difficulties of the preoperative assessment of arterial encasement [3].…”

State of the art and future directions of pancreatic ductal adenocarcinoma therapy

“…A decrease in the level of CA 19-9 may help in decision-making, but only intra-operative biopsy and/or examination of the resected specimen permits conclusions as to the efficacy of neoadjuvant therapy (Bockhorn et al, 2014;Takahashi et al, 2010). Furthermore, there is no consensual agreement on the pathological criteria for defining response (damaged cells, necrosis, fibrosis) and their prognostic value remains controversial; the College of American Pathologists (CAP) score is the most widely used tumor regression grading system but further validation studies are needed (Verbeke, Lohr, Karlsson, & Del Chiaro, 2015;Washington et al, 2014).…”

“…Prospective studies with these intensified regimens in the locally advanced setting are ongoing (NCT02125136, NCT02043730). Of note, the same concerns as for resectable PDAC regarding tumor evaluation by imaging and pathology examination after neoadjuvant treatment have been raised for locally advanced PDAC (Ferrone et al, 2015;Verbeke et al, 2015). As for resectable PDAC, the role of radiotherapy in the management of locally advanced PDAC has been a matter of debate for more than 20 years.…”