A new histological classification for intra-operative histological examination of the ductal resection margin in cholangiocarcinoma |
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| Authors: | Masaru Konishi Atsushi Ochiai Hidenori Ojima Takahiro Hasebe Masayuki Mano Tamaki Ohta Ichiro Ito Keiko Sasaki Satoru Yasukawa Kazuaki Shimada Motoki Iwasaki Akio Yanagisawa |
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| Affiliation: | Upper Gastric Surgery Division and;Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577;;Pathology Division, National Cancer Center Research Institute and;Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045;;Pathology Division, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka 540-0006;;Pathology Division, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Chuo-ku, Niigata 951-8566;;Pathology Division, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777;;Department of Pathology, Kyoto Prefectural University of Medicine, 465 Kajiimachi, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-8566;;Heatobiliary Pancreatic Surgery Division, National Cancer Center Hospital and;Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan |
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| Abstract: | The purpose of this study was to establish a standard histological classification for intra‐operative histological examination of ductal resection margins in cholangiocarcinoma to distinguish between epithelial and intramural lesions and to clarify correlations between the new classification and clinical outcomes. Intra‐operative diagnosis of ductal margins was performed for 357 stumps from 216 patients undergoing surgical resection of cholangiocarcinoma at the National Cancer Center, Japan. Three expert pathologists reviewed the materials and established a histological classification defined by grade of atypia. The new classification comprised four categories: ‘insufficient’, insufficient for diagnosis due to distortion of specimen; ‘negative for malignancy’, no atypia suggestive of neoplasia; ‘undetermined lesion’, specimen showing either cellular or structural atypia; and ‘positive for malignancy’, specimen showing both cellular and structural atypia. Each category was defined to distinguish between epithelial and intramural lesions. Validity and reproducibility of the proposed classification were found to be moderate to substantial. Multivariate analyses using the clinicopathological factors identified to be associated with overall survival by univariate analyses indicated that patients diagnosed with ‘positive for malignancy’ in intramural lesions of the proximal margin displayed significant poor prognosis. Meanwhile, in patients diagnosed with ‘positive for malignancy’ or ‘undetermined lesion’ in epithelial lesions of the proximal margin, no difference in overall survival was apparent compared to patients diagnosed with ‘negative for malignancy’. We propose new histological classification for intra‐operative histological examination of ductal resection margins in cholangiocarcinoma that shows a correlation with patients’ prognosis and should facilitate the determination of ductal resection margin status for cholangiocarcinoma. (Cancer Sci 2009; 100: 255–260) |
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