Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement

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dc.contributor.authorAdsay, N. Volkan
dc.contributor.authorBagci, Pelin
dc.contributor.authorTajiri, Takuma
dc.contributor.authorOliva, Irma
dc.contributor.authorOhike, Nobuyuki
dc.contributor.authorBalci, Serdar
dc.contributor.authorGonzalez, Raul S.
dc.contributor.authorBasturk, Olca
dc.contributor.authorJang, Kee Taek
dc.contributor.authorRoa, Juan Carlos
dc.date.accessioned2024-01-10T12:07:25Z
dc.date.available2024-01-10T12:07:25Z
dc.date.issued2012
dc.description.abstractTumors of the ampulla-pancreatobiliary tract are encountered increasingly; however, their staging can be highly challenging due to lack of familiarity. In this review article, the various issues encountered in staging of these tumors at the pathologic level are evaluated and possible solutions for daily practice as well as potential improvements for future staging protocols are discussed. While N-stage parameters have now been well established (the number of lymph nodes required in pancreatoduodenectomies is 12), the T-staging has several issues: for the pancreas, the discovery of small cancers arising in intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) necessitates the creation of substages of T1 (as T1a, b, and c); lack of proper definition of "peripancreatic soft tissue" and "common bile duct involvement" (as to which part is meant) makes T3 highly subjective. Increasing resectability of main vessels (portal vein) brings the need to redefine a "T" for such cases. For the ampulla, due to factors like anatomic complexity of the region and the under-appreciation of three-dimensional spread of the tumors in this area (in particular, the frequent extension into periduodenal soft tissues and duodenal serosa, which are not addressed in the current system and which require specific grossing approaches to document), the current T-staging lacks reproducibility and clinical relevance, and therefore, major revisions are needed. Recently proposed refined definition and site-specific subclassification of ampullary tumors highlight the areas for improvement. For the extrahepatic bile ducts, the staging schemes that use the depth of invasion may be more practical to circumvent the inconsistencies in the histologic layering of the ducts; better definition of terms like "periductal spread" is needed. For the gallbladder, since many gallbladder cancers are "unapparent" (found in clinically and grossly unsuspected cholecystectomies), establishing proper grossing protocols and adequate sampling are crucial. Since the
dc.fechaingreso.objetodigital2024-04-25
dc.format.extent15 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1053/j.semdp.2012.08.010
dc.identifier.eissn1930-1111
dc.identifier.issn0740-2570
dc.identifier.pubmedidMEDLINE:23062420
dc.identifier.urihttps://doi.org/10.1053/j.semdp.2012.08.010
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/76282
dc.identifier.wosidWOS:000310178500004
dc.information.autorucMedicina;Roa J;S/I;84743
dc.issue.numero3
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final141
dc.pagina.inicio127
dc.publisherW B SAUNDERS CO-ELSEVIER INC
dc.revistaSEMINARS IN DIAGNOSTIC PATHOLOGY
dc.rightsacceso restringido
dc.subjectPancreas
dc.subjectAmpulla
dc.subjectGallbladder
dc.subjectBile duct
dc.subjectStage
dc.subjectLymph node
dc.subjectINDEPENDENT PROGNOSTIC-FACTOR
dc.subjectINTRADUCTAL TUBULAR CARCINOMA
dc.subjectPAPILLARY-MUCINOUS CARCINOMA
dc.subjectLYMPH-NODE INVASION
dc.subjectDUCTAL ADENOCARCINOMAS
dc.subjectNEUROENDOCRINE TUMORS
dc.subjectT-CLASSIFICATION
dc.subjectGASTRIC-CANCER
dc.subjectN-RATIO
dc.subjectSURVIVAL
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titlePathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement
dc.typeartículo
dc.volumen29
sipa.codpersvinculados84743
sipa.indexWOS
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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