Comparing Pathology Report Quality Indicators in 2 Distinct Whipple Resection Specimen Protocols

Area of Science:

• Surgical Pathology
• Oncology
• Medical Diagnostics

Background:

• Pancreaticoduodenectomy specimens are complex and require standardized gross examination for accurate pathological assessment.
• Traditional grossing techniques for these specimens have limitations in comprehensive reporting.
• Implementation of axial sectioning in 2012 aimed to improve the thoroughness of pathology reports.

Purpose of the Study:

• To evaluate the impact of adopting an axial sectioning technique on the completeness and quality of pathology reports for pancreaticoduodenectomy specimens.
• To compare pathology reporting quality between specimens processed using traditional methods versus axial sectioning.

Main Methods:

• A retrospective analysis of pathology reports from two cohorts: 2001-2009 (traditional grossing) and 2012-2017 (axial sectioning).
• Quality indicators including stage, invasion, margins, lymph node status, and specimen size were analyzed.
• Statistical comparison using two-tailed t-tests and Fisher exact tests.

Main Results:

• The axial sectioning cohort showed significantly increased reporting for stage, lymphovascular invasion, margins/surfaces, and mean lymph node count (P < 0.01).
• No significant differences were observed in the reporting of tumor size, grade, or perineural invasion.
• A higher rate of lymph node positivity was noted in the axial sectioning group (86% vs. 65%, P < 0.01).
• Positive superior mesenteric vein/portal vein margins in the axial cohort correlated strongly with superior mesenteric artery/uncinate margin involvement (P = 0.0001).

Conclusions:

• Axial sectioning demonstrates a trend toward higher-quality pathology reports for pancreaticoduodenectomy specimens.
• Increased histopathology slides are a potential drawback of the axial approach.
• Other factors like updated protocols and staging criteria may also contribute to improved reporting quality.