title: Pathologic T1 subclassification of ampullary carcinoma with perisphincteric or duodenal submucosal invasion: Is it T1b?
abstract: BACKGROUND
  In ampullary carcinoma staging, T1 is defined as a tumor limited to the ampulla of Vater or the sphincter of Oddi, and T2 is defined as invasion into the duodenal wall. However, the definition of duodenal wall invasion is vague. Ampullary carcinoma that invades beyond the sphincteric of Oddi (perisphincteric invasion) or into the duodenal submucosa could be considered pT1b because submucosal invasion is classified as pT1b in gastrointestinal tract tumors. However, there are no data regarding T subclassifications for ampullary carcinoma with perisphincteric or duodenal submucosa invasion.
  
  
  OBJECTIVE
  To determine the T subclassification of ampullary carcinoma that invades into perisphincteric or duodenal submucosa.
  
  
  METHODS
  Pathologically proven ampullary carcinomas with T1 or T2 were reviewed (n = 105). We reclassified tumors as pT1a that were limited to within the sphincter of Oddi (n = 40; 38%), as pT1b for tumors that invaded beyond the sphincter of Oddi or into the duodenal submucosa (n = 25; 24%), and as pT2 for tumors that invaded into duodenal proper muscle (n = 40; 38%).
  
  
  RESULTS
  Lymph node metastasis and recurrence were absent in ampullary carcinoma with pT1a, whereas nodal metastasis were noted in 24% (6 of 25) and 40% (16 of 40) of the ampullary carcinomas with pT1b and pT2, respectively. Tumor recurrence/metastasis rate of ampullary carcinoma with pT1b and pT2 was 44% (11 of 25) and 40% (16 of 40), respectively. The 5-year disease-free-survival rates from ampullary carcinoma with pT1a, pT1b, and pT2 were 95% (38 of 40), 56% (14 of 25), and 58% (23 of 40), respectively (P = .003). The 5-year overall survival from ampullary carcinoma with pT1a, pT1b, and pT2 was 98% (39 of 40), 72% (18 of 25), and 60% (24 of 40), respectively.
  
  
  CONCLUSIONS
  The clinicopathologic outcome of ampullary carcinoma with a pT1b subclassification was worse than it was for T1a and approached the outcome for pT2.
authors: From the Department of Surgery, Catholic University of Korea St Vincent's Hospital, Suwon, Korea (Dr You); and the Departments of Pathology (Dr Jang) and Surgery (Drs Heo, S Choi, and D Choi), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: DongDo
authors: D
authors: You
authors: JinSeok
authors: J
authors: Heo
authors: SeongHo
authors: S
authors: Choi
authors: DongWook
authors: D
authors: Choi
authors: Kee-Taek
authors: KT
authors: Jang
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002454:Cell Differentiation; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000556:secondary / Q000601:surgery; D004386:Duodenum / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011379:Prognosis; D009803:Sphincter of Oddi / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D009626:Terminology as Topic; D047368:Tumor Burden