Comparison of pathology sampling protocols for pancreatoduodenectomy specimens

  • Federica GrilloEmail author
  • Jacopo Ferro
  • Alessandro Vanoli
  • Sara Delfanti
  • Francesca Pitto
  • Leonardo Peñuela
  • Rita Bianchi
  • Oneda Grami
  • Roberto Fiocca
  • Luca Mastracci
Original Article
Part of the following topical collections:
  1. Quality in Pathology


Pancreatoduodenectomy is one of the most challenging surgical specimens for pathologists. Recently, two different, standardized protocols have been proposed: the axial slicing Leeds protocol (LP) and the bi-valving Adsay protocol (AP). Comparison between standardized and non-standardized protocols (NSP) was performed with emphasis on margin involvement and lymph node yield. Pancreatoduodenectomy cases were retrospectively recruited: 46 sampled with LP, 52 cases with AP and 46 cases with NSP. Clinico-pathologic data and rates of margin/surface involvement were collected and their prognostic influence on survival was assessed. Statistical differences between NSP and AP and LP were seen for nodal yield (p = 0.0001), N+ (p = 0.0001) and lymph node ratio - LNR (p < 0.0008) but not between AP and LP. Differences in R1/R0 status were statistically significant between NSP group (R1–15%) and both the LP (R1–73.9%) and AP (R1–70%) groups (p = 0.0001) but not between LP and AP groups. At univariate survival analysis, grade (p = 0.0023) and number of involved margins (p = 0.0096) in AP and “N-category” (p = 0.0057) “resection margin status” (p = 0.0094), “stage” (p = 0.0143), and “number of involved margins” (p = 0.00398) in LP were statistically significant, while no variable was significant in the NSP group. At multivariate analysis “N category,” “resection margin status,” “stage,” “number of involved margins,” and “LNR” retained significance for the LP group. These results show that both LP and AP perform better than non-standardized sampling making standardization mandatory in pancreatoduodenectomy cut up. Both AP and LP show strengths and weaknesses, and these may impact on the choice of protocol in different institutions.


Pancreatic cancer Sampling protocols Resection margins Lymph node ratio 



We wish to thank Simona Pigozzi for technical help.

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Federica Grillo, Jacopo Ferro, Alessandro Vanoli, Sara Delfino, Francesca Pitto, Leonardo Peñuela, Rita Bianchi, Oneda Grami, and Luca Mastracci. The first draft of the manuscript was written by Federica Grillo, Alessandro Vanoli, Leonardo Peñuela, and Luca Mastracci, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

This is a retrospective study in which all patients signed informed consent for surgery and histologic diagnosis. All patients were anonymized, and no new histological sections were produced.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
  2. 2.Ospedale Policlinico San Martino GenoaGenoaItaly
  3. 3.Unit of Anatomic Pathology, Department of Molecular MedicineUniversity of PaviaPaviaItaly
  4. 4.Anatomic PathologyFondazione IRCCS Policlinico San MatteoPaviaItaly
  5. 5.Medical OncologyFondazione IRCCS Policlinico San MatteoPaviaItaly

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