Lost in translation: confusion on resection and dissection planes hampers the interpretation of pathology reports for perihilar cholangiocarcinoma

Abstract

Background: In perihilar cholangiocarcinoma (PHC) interpretation of the resection specimen is challenging for pathologists and clinicians alike. Thorough and correct reporting is necessary for reliable interpretation of residual disease status. The aim of this study is to assess completeness of PHC pathology reports in a single center and assess what hampers interpretation of pathology reports by clinicians. Material and Methods: Pathology reports of patients resected for PHC at a single expert tertiary center drafted between 2000 and 2018 were assessed. Reports were assessed regarding completeness, according to the guideline of the International Collaboration on Cancer Reporting (ICCR). Results: A total of 146 reports were assessed. Prognostic tumor characteristics as vasoinvasive growth and perineural growth, were missing in 30/146 (34%) and 22/146 (15%), respectively. One or more planes were missing in 94/146 (64%) of the reports, with the periductal dissection plane missing in 51/145 (35%) (Figure 1). Residual disease could be re-classified from R0 to R1 in 22 patients(15%). Reasons for R1 in these patients were the presence of a positive periductal dissection plane (n = 2), < 1 mm margin at the periductal dissection plane (n = 11) or liver parenchyma (n = 9). Completeness of reports improved significantly when drafted by an expert HPB pathologist. Conclusion: This study demonstrates that pathology reporting of PHC is challenging. Reports are frequently incomplete and often do not incorporate assessment of all resection planes and the dissection plane. The periductal dissection plane is frequently overlooked, but is a major cause of residual disease.