title: Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties.
abstract: An increasing number of studies investigate the use of neoadjuvant treatment for ductal adenocarcinoma of the pancreas. While a strong rationale supports this approach, study results are difficult to interpret and compare due to marked variance in multiple aspects of study design and performance. Divergence in pathology examination and reporting as a cause for heterogeneity and incomparability of study results has not been brought into this discussion yet, despite the fact that several key outcome measures for neoadjuvant treatment are pathology-based. This article discusses areas of controversy and difficulty regarding the evaluation of the extent of residual tumour tissue, grading of tumour regression and assessment of the margins, and explains the important clinical implications of the present uncertainty and divergence in pathology practice.
authors.affiliation: Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden; Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: caroline.verbeke@ki.se.
authors.forename: C
authors.initials: C
authors.lastname: Verbeke
authors.affiliation: Gastrocentrum, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: matthias.lohr@ki.se.
authors.forename: M
authors.initials: M
authors.lastname: Löhr
authors.affiliation: Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: josefin.severin-karlsson@karolinska.se.
authors.forename: J Severin
authors.initials: JS
authors.lastname: Karlsson
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: marco.del-chiaro@karolinska.se.
authors.forename: M
authors.initials: M
authors.lastname: Del Chiaro
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome
keywords: Neoadjuvant treatment; Pancreatic cancer; Pathology; Standardization; Tumour regression