title: A new histological classification for intra-operative histological examination of the ductal resection margin in cholangiocarcinoma.
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.
authors.affiliation: Upper Gastric Surgery Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha,Kashiwa, Chiba, Japan. mkonishi@east.ncc.go.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ochiai
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ojima
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hasebe
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.forename: Tamaki
authors.initials: T
authors.lastname: Ohta
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ito
authors.forename: Keiko
authors.initials: K
authors.lastname: Sasaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Yasukawa
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome