Abstract
Pancreaticoduodenectomy (PD) is currently the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), distal bile duct tumours (DBDT), periampullary duodenal tumours (DT) and tumours of the head of the pancreas (PT). Nodal status and many other important pathological features have a significant impact on tumour prognosis and therapy. The aim of this study was to determine the total number of lymph nodes (LNs) retrieved from PD specimens, whether grouping of LNs improves the total yield and to assess the level completeness of histopathology reporting of PD specimens. Forty two PD requests and histopathology reports were assessed to determine the total number of LNs retrieved and whether the LN were grouped (G)or non-grouped (NG). The significance of difference in the number of LNs in the two groups were assessed using the Wilcoxon signed rank test. The tumours were subcategorized as AVT, DBDT, DT and PT and the reports were audited against the respective minimum data sets of the Royal College of Pathologists of United Kingdom to determine the overall completeness and the parameters poorly reported in the reports. The overall median LN yield was 14.5 and the median LN yield was 15 and 10 in G and NG respectively which was statistically significant. The completeness of the histopathology reporting was 63.6%- 77.3% in AVT (n-18), 73.9% - 95.6% in DBDT (n-5), 68.1% - 90.1% in DT (n-8), 70.8% - 83.3% in PT (n-11). The lengths of the bile duct, lesser and greater curvature of the stomach, tumour differentiation, involvement of resection margins and named blood vessels were poorly reported. In conclusion, the total LN retrieval improved by grouping according to the Union of International Cancer Control (UICC) protocol. Histopathology reporting of some of the data items requires improvement. Hence adoption of a pro forma for synoptic reporting and establishment of national guidelines on reporting and handling of specimens is recommended.
Highlights
Pancreaticoduodenectomy (PD) is currently, the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), PD is curative in 80% of patients with nodenegative ampullary carcinomas
Apart from nodal metastases, which is reflected in the staging of tumours, there are many other important pathological features which have a significant impact on tumour prognosis and therapy that need to be documented in the histopathology report
The total number of lymph nodes (LNs) found in each specimen was determined and the method of identifying LNs established for each case i.e., grouped (G) when the LNs were retrieved from anatomical sites according to the Union of International Cancer Control (UICC) criteria and non- grouped(NG)when LNs were submitted without such grouping (Figure1) [6]
Summary
Pancreaticoduodenectomy (PD) is currently, the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), PD is curative in 80% of patients with nodenegative ampullary carcinomas. Nodal metastasis is considered a major prognostic factor in patients with ampulla of Vater carcinoma [5]. Apart from nodal metastases, which is reflected in the staging of tumours, there are many other important pathological features which have a significant impact on tumour prognosis and therapy that need to be documented in the histopathology report These are incorporated in the minimum data sets that have been formulated – one of which is that drawn up by the Royal College of Pathologists of United Kingdom (RCPUK) [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
