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Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases.
Mod Pathol 2016; 29(12):1575-1585MP

Abstract

Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0.39; P<0.001) with complete agreement in 23%. Using agreement by 3/5 observers as 'consensus' 40% of cases were classified as 'mixed' pancreatobiliary and intestinal. When observers were asked to provide a final diagnosis based on the predominant pattern in cases initially classified as mixed, there was 'moderate' agreement (κ 0.44; P<0.0001) with 5/5 agreeing in 35%. Cases classified as pancreatobiliary by consensus (including those with pure-pancreatobiliary or mixed-predominantly pancreatobiliary features) had shorter overall (median 41 months) and 5-year survival (38%) than those classified as pure-intestinal/mixed-predominantly intestinal (80 months and 57%, respectively; P=0.026); however, on multivariate analysis this was not independent of established prognostic parameters. Interestingly, when compared with 476 cases of pancreatic ductal adenocarcinomas, the pancreatobiliary-type ampullary carcinomas had better survival (16 versus 41 months, P<0.001), even when matched by size and node status. In conclusion, presumably because of the various cell types comprising the region, ampullary carcinomas frequently show mixed phenotypes and intratumoral heterogeneity, which should be considered when devising management protocols. Caution is especially warranted when applying this histologic classification to biopsies and tissue microarrays. While ampullary carcinomas with more pancreatobiliary morphology have a worse prognosis than intestinal ones this does not appear to be an independent prognostic factor. However, pancreatobiliary-type ampullary carcinomas have a much better prognosis than their pancreatic counterparts.

Authors+Show Affiliations

Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan.Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan.Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey.Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey.Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Wayne State University, Detroit, MI, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27586202

Citation

Reid, Michelle D., et al. "Ampullary Carcinoma Is Often of Mixed or Hybrid Histologic Type: an Analysis of Reproducibility and Clinical Relevance of Classification as Pancreatobiliary Versus Intestinal in 232 Cases." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 29, no. 12, 2016, pp. 1575-1585.
Reid MD, Balci S, Ohike N, et al. Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases. Mod Pathol. 2016;29(12):1575-1585.
Reid, M. D., Balci, S., Ohike, N., Xue, Y., Kim, G. E., Tajiri, T., ... Adsay, V. (2016). Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 29(12), pp. 1575-1585. doi:10.1038/modpathol.2016.124.
Reid MD, et al. Ampullary Carcinoma Is Often of Mixed or Hybrid Histologic Type: an Analysis of Reproducibility and Clinical Relevance of Classification as Pancreatobiliary Versus Intestinal in 232 Cases. Mod Pathol. 2016;29(12):1575-1585. PubMed PMID: 27586202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases. AU - Reid,Michelle D, AU - Balci,Serdar, AU - Ohike,Nobuyuki, AU - Xue,Yue, AU - Kim,Grace E, AU - Tajiri,Takuma, AU - Memis,Bahar, AU - Coban,Ipek, AU - Dolgun,Anil, AU - Krasinskas,Alyssa M, AU - Basturk,Olca, AU - Kooby,David A, AU - Sarmiento,Juan M, AU - Maithel,Shishir K, AU - El-Rayes,Bassel F, AU - Adsay,Volkan, Y1 - 2016/09/02/ PY - 2016/02/11/received PY - 2016/06/03/revised PY - 2016/06/03/accepted PY - 2016/9/3/pubmed PY - 2018/1/11/medline PY - 2016/9/3/entrez SP - 1575 EP - 1585 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod. Pathol. VL - 29 IS - 12 N2 - Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0.39; P<0.001) with complete agreement in 23%. Using agreement by 3/5 observers as 'consensus' 40% of cases were classified as 'mixed' pancreatobiliary and intestinal. When observers were asked to provide a final diagnosis based on the predominant pattern in cases initially classified as mixed, there was 'moderate' agreement (κ 0.44; P<0.0001) with 5/5 agreeing in 35%. Cases classified as pancreatobiliary by consensus (including those with pure-pancreatobiliary or mixed-predominantly pancreatobiliary features) had shorter overall (median 41 months) and 5-year survival (38%) than those classified as pure-intestinal/mixed-predominantly intestinal (80 months and 57%, respectively; P=0.026); however, on multivariate analysis this was not independent of established prognostic parameters. Interestingly, when compared with 476 cases of pancreatic ductal adenocarcinomas, the pancreatobiliary-type ampullary carcinomas had better survival (16 versus 41 months, P<0.001), even when matched by size and node status. In conclusion, presumably because of the various cell types comprising the region, ampullary carcinomas frequently show mixed phenotypes and intratumoral heterogeneity, which should be considered when devising management protocols. Caution is especially warranted when applying this histologic classification to biopsies and tissue microarrays. While ampullary carcinomas with more pancreatobiliary morphology have a worse prognosis than intestinal ones this does not appear to be an independent prognostic factor. However, pancreatobiliary-type ampullary carcinomas have a much better prognosis than their pancreatic counterparts. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/27586202/Ampullary_carcinoma_is_often_of_mixed_or_hybrid_histologic_type:_an_analysis_of_reproducibility_and_clinical_relevance_of_classification_as_pancreatobiliary_versus_intestinal_in_232_cases_ L2 - http://dx.doi.org/10.1038/modpathol.2016.124 DB - PRIME DP - Unbound Medicine ER -