Stijn van Roessel1, Eline C Soer2, Susan van Dieren1, Lianne Koens2, Marie Louise F van Velthuysen3, Michael Doukas3, Bas Groot Koerkamp4, Arantza Fariña Sarasqueta5, Carolien M Bronkhorst6, G Mihaela Raicu7, Karel C Kuijpers7, Cornelis A Seldenrijk7, Hjalmar C van Santvoort8, I Quintus Molenaar8, Rachel S van der Post9, Martijn W J Stommel10, Olivier R Busch1, Marc G Besselink11, Lodewijk A A Brosens12, Joanne Verheij13. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 2. Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 3. Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 4. Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 5. Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands. 6. Department of Pathology, Pathology-DNA, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands. 7. Department of Pathology, Pathology-DNA, St. Antonius Hospital, Regional Academic Cancer Center Utrecht (RAKU), Nieuwegein, Utrecht, the Netherlands. 8. Department of Surgery, St. Antonius Hospital, Regional Academic Cancer Center Utrecht (RAKU), Nieuwegein, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Regional Academic Cancer Center Utrecht (RAKU), Nieuwegein, Utrecht, the Netherlands. 9. Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands. 10. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. 11. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 12. Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pathology, University Medical Center Utrecht, Regional Academic Cancer Center Utrecht (RAKU), Nieuwegein, Utrecht, the Netherlands. 13. Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: j.verheij@amsterdamumc.nl.
Abstract
BACKGROUND: In pancreatoduodenectomy specimens, dissection method may affect the assessment of primary tumour origin (i.e. pancreatic, distal bile duct or ampullary adenocarcinoma), which is primarily determined macroscopically. This is the first study to prospectively compare the two commonly used techniques, i.e. axial slicing and bivalving. METHODS: In four centres, a randomized controlled trial was performed in specimens of patients with a suspected (pre)malignant tumour in the pancreatic head. Primary outcome measure was the level of certainty (scale 0-100) regarding tumour origin by four independent gastrointestinal pathologists based on macroscopic assessment. Secondary outcomes were inter-observer agreement and R1 rate. RESULTS: In total, 128 pancreatoduodenectomy specimens were randomized. The level of certainty in determining the primary tumour origin did not differ between axial slicing and bivalving (mean score 72 [sd 13] vs. 68 [sd 16], p = 0.21), nor did inter-observer agreement, both being moderate (kappa 0.45 vs. 0.47). In pancreatic cancer specimens, R1 rate (60% vs. 55%, p = 0.71) and the number of harvested lymph nodes (median 16 vs. 17, p = 0.58) were similar. CONCLUSION: This study demonstrated no differences in determining the tumour origin between axial slicing and bivalving. Both techniques performed similarly regarding inter-observer agreement, R1 rate, and lymph node harvest.
BACKGROUND: In pancreatoduodenectomy specimens, dissection method may affect the assessment of primary tumour origin (i.e. pancreatic, distal bile duct or ampullary adenocarcinoma), which is primarily determined macroscopically. This is the first study to prospectively compare the two commonly used techniques, i.e. axial slicing and bivalving. METHODS: In four centres, a randomized controlled trial was performed in specimens of patients with a suspected (pre)malignant tumour in the pancreatic head. Primary outcome measure was the level of certainty (scale 0-100) regarding tumour origin by four independent gastrointestinal pathologists based on macroscopic assessment. Secondary outcomes were inter-observer agreement and R1 rate. RESULTS: In total, 128 pancreatoduodenectomy specimens were randomized. The level of certainty in determining the primary tumour origin did not differ between axial slicing and bivalving (mean score 72 [sd 13] vs. 68 [sd 16], p = 0.21), nor did inter-observer agreement, both being moderate (kappa 0.45 vs. 0.47). In pancreatic cancer specimens, R1 rate (60% vs. 55%, p = 0.71) and the number of harvested lymph nodes (median 16 vs. 17, p = 0.58) were similar. CONCLUSION: This study demonstrated no differences in determining the tumour origin between axial slicing and bivalving. Both techniques performed similarly regarding inter-observer agreement, R1 rate, and lymph node harvest.
Authors: Carl Stephan Leonhardt; Willem Niesen; Eva Kalkum; Rosa Klotz; Thomas Hank; Markus Wolfgang Büchler; Oliver Strobel; Pascal Probst Journal: BJS Open Date: 2022-03-08