Staley C A, Cleary K R, Abbruzzese J L, Lee J E, Ames F C, Fenoglio C J, Evans D B
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Pancreas. 1996 May;12(4):373-80. doi: 10.1097/00006676-199605000-00009.
A standardized method for pathologic evaluation and staging of pancreaticoduodenectomy (PD) specimens is critical for accurate reporting of the number and location of lymph nodes and margins of resection. We examined the impact of standardized pathologic evaluation (SPE) of PD specimens on the identification of regional lymph nodes and describe our detailed system for the pathologic analysis of the PD specimen. Forty consecutive patients underwent PD for histologically confirmed adenocarcinoma of the pancreatic head between April 1990 and August 1993. Fifteen consecutive specimens were examined before the introduction of the SPE, and 25 consecutive specimens underwent SPE. Resection margins were evaluated by frozen-section analysis, and then the specimen was divided into six regions on an anatomic dissection board for lymph node identification. The 25 specimens examined according to the SPE had a significantly increased number of lymph nodes identified (P = 0.0001) compared with the 15 specimens examined without the SPE. Twelve of the 25 specimens contained positive lymph nodes, 6 of which were confined to the pancreaticoduodenal region. No positive nodes were found in the periaortic region. There were no differences in pathologic variables between patients found to have negative and those with positive regional lymph nodes. SPE of PD specimens provides a method for improved lymph node identification, ensures accurate prospective evaluation of margins of resection, and provides a complete analysis of potentially important pathologic variables. We offer this system as a standardized model for groups engaged in protocol-based clinical research examining innovative multimodality treatment strategies for patients with resectable pancreatic cancer.
胰十二指肠切除术（PD）标本的病理评估和分期的标准化方法对于准确报告淋巴结数量、位置及切除切缘至关重要。我们研究了PD标本的标准化病理评估（SPE）对区域淋巴结识别的影响，并描述了我们对PD标本进行病理分析的详细系统。1990年4月至1993年8月期间，40例连续患者因组织学确诊的胰头腺癌接受了PD手术。在引入SPE之前检查了15例连续标本，25例连续标本接受了SPE。通过冰冻切片分析评估切除切缘，然后在解剖解剖板上将标本分为六个区域以识别淋巴结。与未进行SPE检查的15例标本相比，根据SPE检查的25例标本识别出的淋巴结数量显著增加（P = 0.0001）。25例标本中有12例含有阳性淋巴结，其中6例局限于胰十二指肠区域。在主动脉旁区域未发现阳性淋巴结。区域淋巴结为阴性和阳性的患者之间的病理变量没有差异。PD标本的SPE提供了一种改进淋巴结识别的方法，确保了对切除切缘的准确前瞻性评估，并对潜在重要的病理变量进行了完整分析。我们将此系统作为一个标准化模型提供给参与基于方案的临床研究的团队，这些研究旨在研究可切除胰腺癌患者的创新多模态治疗策略。
