Reclassification of tumour origin in resected periampullary adenocarcinomas reveals underestimation of distal bile duct cancer

Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma – A population-based cohort study

“…Distal bile duct cancer was most frequently misdiagnosed, and patients with distal bile duct cancer who were previously erroneously diagnosed as PDaC patients caused a falsely favourable prognosis for PDaC in the survival analysis. The large variation in reported five-year survival after pancreatoduodenectomy for PDaC in the literature (5-25%) can at least partly be explained by inaccuracies in the histopathological evaluation [39]. Some multicentre studies included good performance status patients with strict tumour biology inclusion criteria, such as low Ca 19-9 levels, that also may explain the better five-years survival than in our population-based study [18].…”

“…For example, the five-year survival rates in the largest randomised studies on aC in PDaC was 21%, 22.5% and 20%, respectively [11,18,24]. Our institution has recently shown that specialist slide review of histopathology resulted in reassignment of tumour origin in 27% of periampullary adenocarcinomas [39]. Distal bile duct cancer was most frequently misdiagnosed, and patients with distal bile duct cancer who were previously erroneously diagnosed as PDaC patients caused a falsely favourable prognosis for PDaC in the survival analysis.…”

Difficult Diagnostic Problems in Pancreatobiliary Neoplasia

“…33 Distal bile duct carcinomas are frequently misclassified as either PDAC or ampullary carcinoma, and survival in cases reclassified from PDAC is better than it is in true PDAC. 37 The distinction may also have therapeutic implications; in one study, 38 treatment of patients who have bile duct carcinoma (including advanced or metastatic cholangiocarcinoma, gallbladder cancer, and ampullary cancer) with cisplatin plus gemcitabine (the latter being a key agent used to treat PDAC) was associated with a significant survival advantage as compared with use of gemcitabine alone, without the addition of substantial toxicity.…”

Carcinoma of Ampulla of Vater: Carcinogenesis and Immunophenotypic Evaluation

“…Histopathologic evaluation may vary depending on the protocols adopted by the institutions and also depending on the individual experience of the pathologist (interobserver variability). The report assessed the pathologist about periampullary cancer is extremely important to confirm the diagnosis, determining prognosis, selection of potential patients for clinical trials of adjuvant treatment, as well as providing radiological and surgical correlation and collect data for records of population-based epidemiology and câncer [22].…”

“…Just as large tumors of the head of the pancreas, bile duct or duodenum may grow and involve the ampulla of Vater resembling a primary neoplasm ampullary [22].…”