Kendall Timothy, Overi Diletta, Guido Maria, Braconi Chiara, Banales Jesus, Cardinale Vincenzo, Gaudio Eugenio, Groot Koerkamp Bas, Carpino Guido
University of Edinburgh Centre for Inflammation Research and Edinburgh Pathology, University of Edinburgh, Edinburgh, UK.
Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy.
JHEP Rep. 2024 Mar 12;6(6):101067. doi: 10.1016/j.jhepr.2024.101067. eCollection 2024 Jun.
BACKGROUND & AIMS: Patients with intrahepatic cholangiocarcinoma can now be managed with targeted therapies directed against specific molecular alterations. Consequently, tissue samples submitted to the pathology department must produce molecular information in addition to a diagnosis or, for resection specimens, staging information. The pathologist's role when evaluating these specimens has therefore changed to accommodate such personalised approaches.
We developed recommendations and guidance for pathologists by conducting a systematic review of existing guidance to generate candidate statements followed by an international Delphi process. Fifty-nine pathologists from 28 countries in six continents rated statements mapped to all elements of the specimen pathway from receipt in the pathology department to authorisation of the final written report. A separate survey of 'end-users' of the report including surgeons, oncologists, and gastroenterologists was undertaken to evaluate what information should be included in the written report to enable appropriate patient management.
Forty-eight statements reached consensus for inclusion in the guidance including 10 statements about the content of the written report that also reached consensus by end-user participants. A reporting proforma to allow easy inclusion of the recommended data points was developed.
These guiding principles and recommendations provide a framework to allow pathologists reporting on patients with intrahepatic cholangiocarcinoma to maximise the informational yield of specimens required for personalised patient management.
Biopsy or resection lesional tissue from intrahepatic cholangiocarcinoma must yield information about the molecular abnormalities within the tumour that define suitability for personalised therapies in addition to a diagnosis and staging information. Here, we have developed international consensus guidance for pathologists that report such cases using a Delphi process that sought the views of both pathologists and 'end-users of pathology reports. The guide highlights the need to report cases in a way that preserves tissue for molecular testing and emphasises that reporting requires interpretation of histological characteristics within the broader clinical and radiological context. The guide will allow pathologists to report cases of intrahepatic cholangiocarcinoma in a uniform manner that maximises the value of the tissue received to facilitate optimal multidisciplinary patient management.
肝内胆管癌患者现在可以接受针对特定分子改变的靶向治疗。因此，提交给病理科的组织样本除了要给出诊断结果外，对于切除标本还需提供分期信息，同时必须生成分子信息。病理学家在评估这些标本时的角色因此发生了变化，以适应这种个性化治疗方法。
我们通过对现有指南进行系统回顾以生成候选声明，随后开展国际德尔菲法，为病理学家制定了建议和指南。来自六大洲28个国家的59名病理学家对从标本送达病理科到最终书面报告授权的标本流程所有环节的声明进行了评分。我们还对报告的“最终用户”（包括外科医生、肿瘤学家和胃肠病学家）进行了单独调查，以评估书面报告中应包含哪些信息，以便对患者进行适当管理。
48条声明达成共识，被纳入指南，其中包括10条关于书面报告内容的声明，最终用户参与者也对此达成了共识。我们制定了一份报告模板，以便轻松纳入推荐的数据点。
这些指导原则和建议提供了一个框架，使报告肝内胆管癌患者情况的病理学家能够最大限度地提高个性化患者管理所需标本的信息产出。
肝内胆管癌的活检或切除病变组织除了要提供诊断和分期信息外，还必须提供有关肿瘤内分子异常的信息，这些信息可确定患者是否适合接受个性化治疗。在此，我们通过德尔菲法为报告此类病例的病理学家制定了国际共识指南，该方法征求了病理学家和病理报告“最终用户”的意见。该指南强调了以保留组织用于分子检测的方式报告病例的必要性，并强调报告需要在更广泛的临床和放射学背景下解读组织学特征。该指南将使病理学家能够以统一的方式报告肝内胆管癌病例，最大限度地提高所接收组织的价值，以促进最佳的多学科患者管理。
