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Most pathology reports are in a narrative form without a given structure and occasionally lack important information. Here we show that the format of pathology reports of oncological lung resection specimens correlates with the quality of the reports. All pathology reports of oncological lung resection specimens between 01/02 and 04/11 (N = 878) were classified into descriptive reports (DR, N = 249), structured reports (SR, N = 415) as well as template based synoptic reports (TBSR, N = 214) and compared regarding the content of organ specific essential data (ED). The amount of recorded ED was summarized in an essential data score (EDS). Median EDS of DR was 8, of SR 9, and of TBSR 10. Only 28.7% of all reports had an EDS of 10; divided into the report types 2.6% of DR, 16.4% of SR and 88.4% of TBSR obtained an EDS of 10 (paired comparison: P < 0.0001). Traditional descriptive reports showed the lowest quality sometimes lacking important information and clarity of data layout whereas the template based synoptic reports reached the highest quality level. The broader use of structured reports is recommended for oncological lung resection specimens as they lead to a reduction of failed data transfer and therefore to an increase of quality.

To analyze our experience in patients with duodenal gastrointestinal stromal tumors (GIST) and review the appropriate surgical approach.We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011. Patient files, operative reports, radiological charts and pathology were analyzed. For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection (LR). For extended resection pancreatoduodenectomy was performed. Age, gender, clinical symptoms of the tumor, anatomical localization, tumor size, mitotic count, type of resection resectional status, neoadjuvant therapy, adjuvant therapy, risk classification and follow-up details were investigated in this retrospective study.Nine patients (5 males/4 females) with a median age of 58 years were surgically treated. The median follow-up period was 45 mo (range 6-111 mo). The initial symptom in 6 of 9 patients was gastrointestinal bleeding (67%). Tumors were found in all four parts of the duodenum, but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients (33%). Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection. In one patient, the GIST resection was done by pancreatoduodenectomy. The 8 LRs included a segmental resection of pars 4 of the duodenum, 5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy. One of these LRs was done minimally invasive; seven were done in open fashion. The median diameter of the tumors was 54 mm (14-110 mm). Using the Fletcher classification scheme, 3/9 (33%) tumors had high risk, 1/9 (11%) had intermediate risk, 4/9 (44%) had low risk, and 1/9 (11%) had very low risk for aggressive behaviour. Seven resections showed microscopically negative transsection margins (R0), two showed positive margins (R1). No patient developed local recurrence during follow-up. The one patient who underwent pancreatoduodenectomy died due to progressive disease with hepatic metastasis but without evidence of local recurrence. Another patient died in complete remission due to cardiac disease. Seven of the nine patients are alive disease-free.In patients with duodenal GIST, limited surgical resection with microscopically negative margins, but also with microscopically positive margins, lead to very good local and systemic disease-free survival.

Introduction: When tumors are found to be adherent to the superior mesenteric or portal vein during pancreatoduodenectomy, en bloc portal venous resection (PVR) is an option to achieve complete tumor resection. It has also been reported that PVR without confirmed histopathologic portal venous infiltration (PVI) is associated with significantly better survival. The aim of this study was to evaluate oncologic outcome and prognostic factors in patients receiving PVR for pancreatic cancer. Methods: A unicenter retrospective study was performed on the basis of a prospectively maintained database. IBM SPSS Version 21 was used for all calculations with the significance level set to p=0.05. Results: From 2001 to 2013, 103 patients received pancreatoduodenectomy with PVR for pancreatic head cancer. Median survival in patients with PVR without PVI was 25 months, whereas confirmed PVI was associated with poor median survival of 14 months (p

Objective: MRI has been shown to be more accurate than CT in the diagnoses and characterization of hepatic lesions. However, it is unclear how MRI affects surgical decision making. The objective of this study is to identify the effect of MRI on clinical management of hepatic lesions after initial CT evaluation. Methods: A retrospective review of a prospective liver database between 2004 and 2013 was performed and a total of 102 cases in 101 patients were identified that underwent CT followed by MRI within 30 days to characterize hepatic lesions being evaluated for surgical treatment. The findings between CT and MRI were compared to identify differences in location, size, number and characterization of hepatic lesions. Diagnoses were confirmed by operative findings/pathology and follow up on imaging. The effect of MRI on management was classified into three categories: 1) No change from CT, 2) Diagnostic clarification leading to no surgery (A: unresectable, B: no indication for surgery, C: change in non-surgical treatment), and 3) Change in extent of surgical resection (A: larger resection, B: smaller resection) Results: In the 102 cases, the major tumor histology groups were as follows: benign [9 (9%)], colorectal metastases [47 (46%)], HCC/cholangiocarcinoma [26 (25%)], neuroendocrine metastases [12 (12%)], and other [8 (8%)]. Category 1 had 57 cases (56%), category 2 had 19 cases (19%), and category 3 had 26 cases (25%). Of the 19 category 2 cases, there were eight 2A, nine 2B and two 2C cases. Of the 26 category 3 cases, there were fifteen 3A cases and eleven 3B cases. The number of tumors on CT [Mean 1.6 (category 1) vs. 2.4 (categories 2 and 3), p=0.0034] was significantly associated with MRI imaging leading to a change in management. The maximum tumor size on CT [Mean 4.0 (category 1) vs. 2.7 (category 2 and 3), p=0.0714] suggested a trend towards MRI having an effect on surgical management. Factors such as age, gender, BMI, cirrhosis, prior chemotherapy, tumor histology, vascular invasion on CT, and tumor location on CT were not significantly associated with MRI category 2 or 3. Conclusion: The use of MRI in the surgical evaluation of hepatic lesions after initial CT scan changed management in 44% of cases. Multiple lesions and smaller lesions seen on CT may derive the most benefit from application of MRI imaging.

Background and Aim: Pancreatic ductal adenocarcinoma (PDAC) is characterized by aggressive biology and poor prognosis even after resection. Long term survival is very rare and cannot be reliably predicted. Experimental data suggest an important role of epithelialmesenchymal transition (EMT) in invasion and metastasis of PDAC. Tumor budding is regarded as the morphologic correlate of local invasion and cancer cell dissemination. The aim of this study was to evaluate the biologic and prognostic implications of EMT and tumor budding in PDAC of the pancreatic head. Methods: Patients were identified from a prospectively maintained database and baseline, operative, histopathologic and follow-up data extracted. Serial tissue slices stained for Pan-Cytokeratin (PCK) served for analysis of tumor budding, and E-Cadherin (ECad), Beta-Catenin (BCat) and Vimentin (VIM) staining for analysis of EMT. Baseline, operative, standard pathology and immunohistochemical parameters were evaluated for prediction of long term survival (>= 30 months) in uniand multivariate analysis. Results: Intraand intertumoral patterns of EMT marker expression and tumor budding provide evidence of partial EMT induction at the tumor-host interface. Lymph node ratio (LNR) and E-Cadherin expression in tumor buds were independent predictors of long term survival in multivariate analysis. Conclusions: Detailed immunohistochemic assessment confirms a relationship between EMT and tumor budding at the tumorhost interface. A small group of patients with favorable prognosis can be identified by combined assessment of LNR and EMT in tumor buds.

s / Pancreatology 13 (2013) S2–S98 S85 1 Surgical and Emergency Unit, Department of Internal Medicine and Surgery, S.Orsola-Malpighi Hospital, University of Bologna, Italy 2 Internal Medicine Unit, Department of Internal Medicine and Surgery, S.Orsola-Malpighi Hospital, University of Bologna, Italy 3 Pathological Unit, Department of Hematology, Oncology and Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Italy Introduction: In 2012 the IPMNs International Consensus Guidelines changed the criteria for surgery and the definition of “malignancy”, reserving this term only for invasive carcinoma Aims: To evaluate the accuracy of surgical criteria to predict malignancy. Patients & methods: From 2003 to 2012, data regarding 184 patients with IPMNs, were recorded. Forty-two (22.8 %) patients, undergoing surgery, were evaluated according to the new guidelines. Criteria for surgery (cyst size, Wirsung dilatation, symptoms and presence of solid endocystic component) were studied to assess the malignancy in patients affected by IPMNs. Multivariate analysis was carried out comparing the new (only invasive carcinoma) and old definition of malignancy (invasive carcinoma and high grade dysplasia). Results: All operated patients presented criteria for surgery. Malignancy was recorded in 21 (50%) and 17 (40.5%) patients, according to the Sendai and Fukuoka definitions. At multivariate analysis no factors predicted malignancy according to Fukuoka definition, while presence of ESC (RR 14.2; C.I. 95% 1.8-113.5; P1⁄40.012) and cystic size (RR 1.1; CI 95% 1.021.20; P1⁄40.019) were related to malignancy according to Sendai definition. A dimensional cut-off of the cystic lesion of 26 mm was obtained with a ROC curve (AUC1⁄4 0.724; P1⁄40.013). At the multivariate analysis, this cut-off resulted the strongest indipendent factor predicting malignancy according to Sendai definition (RR 8.0; CI 95% 1.13-56.95; P1⁄40.037). Conclusion: In our experience, surgical criteria seem to be inefficacy to predict presence of invasive carcinoma. ESC and cystic size were the only factors able to detect patients with high grade dysplasia or invasive carcinoma and to suggest the surgical approach. PII-110 Abstract id: 331. A unifying concept for periampullary adenocarcinomas Peter Bronsert , Ilona Kohler , Martin Werner , Frank Makowiec , Dirk Bausch , Ulrich Theodor Hopt , Tobias Keck , Ulrich Friedrich Wellner . University of Freiburg, Germany UKSH Campus L€ ubeck, Germany Introduction: Periampullary adenocarcinomas comprise pancreatic, distal bile duct, ampullary and duodenal adenocarcinoma. The epithelia of these anatomical structures share a common embryologic origin from the foregut. With steadily increasing numbers of pancreatoduodenectomies over the last decades, pathologists, surgeons and oncologists are more often confronted with the diagnosis of “other than pancreatic” periampullary cancers. The intestinal subtype of ampullary cancer has been shown to correlate with better prognosis. Aims: clinical and histopathological evaluation of intestinal vs pancreatobiliary differentiation in duodenal, ampullary, bile duct and pancreatic adenocarcinoma Patients & methods: From n1⁄4198 cases of periampullary carcinoma with clinical follow-up, evaluation of histological subtype and immunohistochemical staining pattern for CK7, CK20 and CDX2 was done by two experienced pathologists. Routine pathological parameters were included in survival analysis performed with SPSS 20. Results: In univariate analysis, intestinal subtype was associated with better survival in ampullary, pancreatic ductal and duodenal adenocarcinoma. Intestinal differentiation and lymph node ratio, but not tumor location were independent predictors of survival when all significant predictor variables from univariate analysis (grade, TNM stage, presence of precursor lesions, surgical margin status, perineural, vascular and lymphatic vessel invasion, CK7 and CDX2 staining pattern) were included in a Cox proportional hazards model. Conclusion: Intestinal type differentiation of periampullary carcinomas and lymph node ratio are independent prognostic factors not only in ampullary, but also in other periampullary adenocarcinomas like pancreatic ductal adenocarcinoma. Differentiation is more important than tumor location for prognostic stratification in periampullary carcinomas. PII-111 Abstract id: 114. Diagnostic accuracy of contrast-enhanced computed tomography in assessing extra-regional lymphadenopathy in pancreatic and periampullary cancer: A systematic review Dorine S.J. Tseng , Hjalmar C. van Santvoort , Samira Fegrachi , Marc G.H. Besselink , Inne H.M. Borel Rinkes , Maarten S. van Leeuwen , I. Quintus Molenaar . University Medical Center Utrecht, Netherlands Academic Medical Center Amsterdam, Netherlands Introduction: Computed tomography (CT) is the most widely used method for assessing resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is extra-regional lymph node (ELN) metastases. Aims: The aim of this study was to determine the diagnostic accuracy of CT in assessing ELN metastases in pancreatic and peri-ampullary cancer. Patients & methods: We systematically reviewed the literature published up to November 29th 2012, according to the PRISMA guidelines. Studies reporting on CT and histopathological assessment of ELN in patients undergoing pancreatoduodenectomy were included. We excluded studies were data on CT and ELN were not reported. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data. Results: After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or periampullary cancer were included. Histopathologically proven ELN metastases were present in 28/157(18%) patients, which had been diagnosed on CT in 7(25%) patients. CT falsely suggested presence of ELN metastases in 18/129(14%) patients. Overall, diagnostic accuracy, specificity and NPV varied from 63-81, 80-100% and 67-90% respectively. However, PPV and sensitivity ranged from 0-100% and 0-38%. Pooled accuracy, sensitivity, specificity, PPV and NPV were 75%, 25%, 86%, 28% and 84% respectively. Conclusion: CT has a low diagnostic accuracy in assessing ELN metastases in patient with pancreatic or peri-ampullary cancer. Therefore the suspicion of ELN metastases on CT should not be a contra-indication for explorative laparotomy and, when possible, pancreatoduodenectomy. PII-112 Abstract id: 121. Clinical behavior in 63 patients with branch duct type of intraductal papillary mucinous neoplasm Arichika Hoshino , Hiroyuki Suzuki , Takayuki Aimoto , Satoshi Mizutani , Eiji Uchida . Nippon Medical School Musashikosugi Hospital, Japan Nippon Medical School, Japan Introduction: An international consensus conference has recommended close follow-up in patients with branch duct type of intraductal papillary mucinous neoplasm (BD-IPMN), even if no symptoms, smaller than 30 mm in diameter and no mural nodules. Aims: This study investigated whether the recommendation could be appropriate in a single-centre experience. Patients & methods: Sixty-three patients who were diagnosed with BD-IPMN at our institute between 2000 and 2012 were enrolled in this study. At the first presentation, all patients were asymptomatic and had a

The exact role of neoadjuvant therapy (neoT) including its prognostic influence in esophageal cancer is still under debate. Pooled data (metaanalysis) suggest a prognostic advantage of neoT but definitve data are lacking. We analyzed our institutional experience with resected esophageal cancer including the effect of neodjuvant therapy on long-term outcome. Methods: We evaluated overall survival in 304 patients undergoing esophageal resection between 1988 and 2010 (patients with hospital mortality excluded). 53% had squamous cell (SCC) and 46% adenocarcinoma (AC). Indications for neoT were in general T-stage >2 and/or positively staged lymph nodes. Tumors were in the lower third in 64%. 66% of the patients underwent neoT (60% chemoradiation 36 Gy+FU+Cisplatin; 6% chemotherapy alone). The proportion of neoT increased from 16% in the first third to 78% in the last third of the study period. In pathological analysis the median number of examined nodes was 17; 43% were node positive. Survival was analyzed by the Kaplan-Meierand Cox-models. Results: The proportion of patients with AC increased from 22% (first third) to 61% (last third of the study period). After neoT 81% of the patients showed partial or total response. Patients without neoT had more frequently positive margins (13% vs 4% after neoT; p 0.1 (p 0.1 (p 0.1 (43% vs 16%). Conclusions: Tumorbiological parameters (histological type, LNratio) influenced prognosis after resection of esophageal cancer. Response to neoadjuvant therapy independently improved the outcome and contributed to the clearly better outcome achieved in the later study period.

BackgroundMass spectrometry imaging is increasingly used in biological and translational research as it has the ability to determine the spatial distribution of hundreds of analytes in a sample. Being at the interface of proteomics/metabolomics and imaging, the acquired data sets are large and complex and often analyzed with proprietary software or in-house scripts, which hinder reproducibility. Open source software solutions that enable reproducible data analysis often require programming skills and are therefore not accessible to many MSI researchers.FindingsWe have integrated 18 dedicated mass spectrometry imaging tools into the Galaxy framework to allow accessible, reproducible, and transparent data analysis. Our tools are based on Cardinal, MALDIquant, and scikit-image and enable all major MSI analysis steps such as quality control, visualization, preprocessing, statistical analysis, and image co-registration. Further, we created hands-on training material for use cases in proteomics and metabolomics. To demonstrate the utility of our tools, we re-analyzed a publicly available N-linked glycan imaging dataset. By providing the entire analysis history online, we highlight how the Galaxy framework fosters transparent and reproducible research.ConclusionThe Galaxy framework has emerged as a powerful analysis platform for the analysis of MSI data with ease of use and access together with high levels of reproducibility and transparency.

Background Ampullary cancer is a relatively rare form of cancer and usually treated by pancreatoduodenectomy, followed by adjuvant therapy. The intestinal subtype is associated with markedly improved prognosis after resection. At present, only few cell lines are available for in vitro studies of ampullary cancer and they have not been collectively characterized. Methods We characterize five ampullary cancer cell lines by subtype maker expression, epithelial-mesenchymal transition (EMT) features, growth and invasion, drug sensitivity and response to cancer-associated fibroblast conditioned medium (CAF-CM). Results On the basis of EMT features, subtype marker expression, growth, invasion and drug sensitivity three types of cell lines could be distinguished: mesenchymal-like, pancreatobiliary-like and intestinal-like. Heterogeneous effects from the cell lines in response to CAF-CM, such as different growth rates, induction of EMT markers as well as suppression of intestinal differentiation markers were observed. In addition, proteomic analysis showed a clear difference in intestinal-like cell line from other cell lines. Conclusion Most of the available AMPAC cell lines seem to reflect a poorly differentiated pancreatobiliary or mesenchymal-like phenotype, which is consistent to their origin. We suggest that the most appropriate cell line model for intestinal-like AMPAC is the SNU869, while others seem to reflect aggressive AMPAC subtypes. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2193-5) contains supplementary material, which is available to authorized users.