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Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of verona consensus meeting

Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of verona consensus meeting
Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of verona consensus meeting
Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs).Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy–2013, was tasked to devise recommendations.Results: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term “minimally invasive” should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤0.5, >0.5–≤1, >1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of “indeterminate/(suspicious) for invasion” is acceptable for rare cases. (6) The term “malignant” IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic).Conclusions: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.
0003-4932
162-177
Adsay, Volkan
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Mino-Kenudson, Mari
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Furukawa, Toru
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Basturk, Olca
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Zamboni, Giuseppe
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Marchegiani, Giovanni
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Bassi, Claudio
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Salvia, Roberto
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Malleo, Giuseppe
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Paiella, Salvatore
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Wolfgang, Christopher L.
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Matthaei, Hanno
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Offerhaus, G. Johan
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Adham, Mustapha
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Bruno, Marco J.
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Reid, Michelle D.
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Krasinskas, Alyssa
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Klöppel, Günter
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Ohike, Nobuyuki
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Tajiri, Takuma
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Jang, Kee-Taek
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Roa, Juan Carlos
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Allen, Peter
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Fernández-del Castillo, Carlos
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Jang, Jin-Young
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Klimstra, David S.
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Hruban, Ralph H.
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Abu Hilal, Mohammad
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Adsay, Volkan
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Mino-Kenudson, Mari
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Furukawa, Toru
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Basturk, Olca
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Zamboni, Giuseppe
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Marchegiani, Giovanni
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Bassi, Claudio
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Salvia, Roberto
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Malleo, Giuseppe
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Paiella, Salvatore
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Wolfgang, Christopher L.
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Matthaei, Hanno
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Offerhaus, G. Johan
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Adham, Mustapha
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Bruno, Marco J.
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Reid, Michelle D.
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Krasinskas, Alyssa
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Klöppel, Günter
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Ohike, Nobuyuki
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Tajiri, Takuma
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Jang, Kee-Taek
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Roa, Juan Carlos
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Allen, Peter
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Fernández-del Castillo, Carlos
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Jang, Jin-Young
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Klimstra, David S.
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Hruban, Ralph H.
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Abu Hilal, Mohammad
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Adsay, Volkan, Mino-Kenudson, Mari and Furukawa, Toru et al. (2016) Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: recommendations of verona consensus meeting. Annals of Surgery, 263 (1), 162-177. (doi:10.1097/SLA.0000000000001173). (PMID:25775066)

Record type: Article

Abstract

Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs).Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy–2013, was tasked to devise recommendations.Results: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term “minimally invasive” should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤0.5, >0.5–≤1, >1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of “indeterminate/(suspicious) for invasion” is acceptable for rare cases. (6) The term “malignant” IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic).Conclusions: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.

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Published date: January 2016
Organisations: Cancer Sciences

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Local EPrints ID: 400311
URI: https://eprints.soton.ac.uk/id/eprint/400311
ISSN: 0003-4932
PURE UUID: d6e6dc96-6653-41a8-850f-433eca259732

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Date deposited: 14 Sep 2016 10:36
Last modified: 15 Jun 2018 16:31

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Contributors

Author: Volkan Adsay
Author: Mari Mino-Kenudson
Author: Toru Furukawa
Author: Olca Basturk
Author: Giuseppe Zamboni
Author: Giovanni Marchegiani
Author: Claudio Bassi
Author: Roberto Salvia
Author: Giuseppe Malleo
Author: Salvatore Paiella
Author: Christopher L. Wolfgang
Author: Hanno Matthaei
Author: G. Johan Offerhaus
Author: Mustapha Adham
Author: Marco J. Bruno
Author: Michelle D. Reid
Author: Alyssa Krasinskas
Author: Günter Klöppel
Author: Nobuyuki Ohike
Author: Takuma Tajiri
Author: Kee-Taek Jang
Author: Juan Carlos Roa
Author: Peter Allen
Author: Carlos Fernández-del Castillo
Author: Jin-Young Jang
Author: David S. Klimstra
Author: Ralph H. Hruban
Author: Mohammad Abu Hilal

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