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Biliary intraepithelial neoplasia (BilIN) is frequently found in surgical margins of biliary tract cancer resection specimens but has no clinical implications.
- Source :
-
Virchows Archiv : an international journal of pathology [Virchows Arch] 2015 Feb; Vol. 466 (2), pp. 133-41. Date of Electronic Publication: 2014 Nov 26. - Publication Year :
- 2015
-
Abstract
- Biliary tract cancers are aggressive tumors of which the incidence seems to increase. Resection with cancer-free margins is crucial for curative therapy. However, how often biliary intraepithelial neoplasia (BilIN) occurs in resection margins and what its clinical and therapeutic implications might be is largely unknown. We reexamined margins of resection specimens of adenocarcinoma of the biliary tree including the gallbladder for the presence of BilIN. When present, it was graded. The findings were correlated with clinicopathological parameters and overall survival. Complete examination of the resection margin could be performed on 55 of 78 specimens (71%). BilIN was detected in the margin in 29 specimens (53%) and was mainly low-grade (BilIN-1; N = 14 of 29; 48%). In resection specimens of extrahepatic cholangiocarcinoma, BilIN was most frequent (N = 6 of 8; 75%). BilIN was found in the resection margin more frequently in extrahepatic cholangiocarcinomas (P = 0.007) and in large primary tumors (P = 0.001) with lymphovascular (P = 0.006) and perineural invasion (P = 0.049). Patients with cancer in the resection margin (R1) had a significantly shorter overall survival than those with resection margins free of tumor (R0) irrespective of the presence of BilIN (R0 vs R1; P < 0.001) or BilIN grade (BilIN-positive vs BilIN-negative, P = 0.6, and BilIN-1 + 2 vs BilIN-3, P = 0.58). BilIN is frequently found in the surgical margin of resection specimens of adenocarcinoma of the biliary tract. Hepatopancreatobiliary surgeons will be confronted with this recently defined entity when an intraoperative frozen section of a resection margin is requested. However, this diagnosis does not require additional resection and in the intraoperative evaluation of resection, the emphasis should remain on the detection of residual invasive tumor.
- Subjects :
- Adenocarcinoma mortality
Adult
Aged
Biliary Tract Neoplasms mortality
Carcinoma in Situ mortality
Female
Humans
Infant, Newborn
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm, Residual mortality
Neoplasm, Residual pathology
Proportional Hazards Models
Adenocarcinoma pathology
Biliary Tract Neoplasms pathology
Carcinoma in Situ pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2307
- Volume :
- 466
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Virchows Archiv : an international journal of pathology
- Publication Type :
- Academic Journal
- Accession number :
- 25425476
- Full Text :
- https://doi.org/10.1007/s00428-014-1689-0