Protocol for the examination of specimens from patients with carcinoma of the perihilar bile ducts.

Full text

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Protocol for the Examination of Specimens From
Patients With Carcinoma of the Perihilar Bile Ducts
Protocol applies to all invasive carcinomas of the perihilar bile
ducts. Carcinomas of the distal extrahepatic bile ducts,
intrahepatic bile ducts, and well-differentiated neuroendocrine
neoplasms (carcinoid tumors) are not included.

Based on AJCC/UICC TNM, 7th edition
Protocol web posting date: October 2009

Procedures
• Local or Segmental Bile Duct Resection
• Hilar Resection with or without Hepatic Resection

Authors
Kay Washington, MD, PhD, FCAP*
Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
Jordan Berlin, MD
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
Philip Branton, MD, FCAP
Department of Pathology, Inova Fairfax Hospital, Falls Church, VA
Lawrence J. Burgart, MD, FCAP
Allina Laboratories, Abbott Northwestern Hospital, Minneapolis, MN
David K. Carter, MD, FCAP

Department of Pathology, St. Mary’s/Duluth Clinic Health System, Duluth, MN
Carolyn C. Compton, MD, PhD, FCAP
Office of Biorepositories and Biospecimen Research, National Cancer Institute, Bethesda,
MD
Patrick Fitzgibbons, MD, FCAP
Department of Pathology, St. Jude Medical Center, Fullerton, CA
Wendy L. Frankel, MD, FCAP
Department of Pathology, Ohio State University Medical Center, Columbus, OH
John Jessup, MD
Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
Sanjay Kakar, MD, FCAP
Department of Pathology, University of California San Francisco and the Veterans Affairs
Medical Center, San Francisco, CA
Bruce Minsky, MD
Department of Radiation Oncology, University of Chicago, Chicago, IL
Raouf Nakhleh, MD, FCAP
Department of Pathology, Mayo Clinic, Jacksonville, FL
Jean-Nicolas Vauthey, MD†
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center,
Houston, TX
For the Members of the Cancer Committee, College of American Pathologists

*denotes primary author. † denotes senior author. All other contributing authors are listed alphabetically.

Previous contributors: Jorge Albores-Saavedra, MD; Donald E. Henson, MD

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Gastrointestinal • Perihilar Bile Ducts
PerihilarBileDuct 3.0.0.0
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© 2009 College of American Pathologists (CAP). All rights reserved.
The College does not permit reproduction of any substantial portion of these protocols without its
written authorization. The College hereby authorizes use of these protocols by physicians and
other health care providers in reporting on surgical specimens, in teaching, and in carrying out
medical research for nonprofit purposes. This authorization does not extend to reproduction or
other use of any substantial portion of these protocols for commercial purposes without the written
consent of the College.
The CAP also authorizes physicians and other health care practitioners to make modified versions
of the Protocols solely for their individual use in reporting on surgical specimens for individual
patients, teaching, and carrying out medical research for non-profit purposes.
The CAP further authorizes the following uses by physicians and other health care practitioners, in
reporting on surgical specimens for individual patients, in teaching, and in carrying out medical
research for non-profit purposes: (1) Dictation from the original or modified protocols for the
purposes of creating a text-based patient record on paper, or in a word processing document; (2)
Copying from the original or modified protocols into a text-based patient record on paper, or in a
word processing document; (3) The use of a computerized system for items (1) and (2),
provided that the Protocol data is stored intact as a single text-based document, and is not stored
as multiple discrete data fields.
Other than uses (1), (2), and (3) above, the CAP does not authorize any use of the Protocols in
electronic medical records systems, pathology informatics systems, cancer registry computer
systems, computerized databases, mappings between coding works, or any computerized system
without a written license from CAP. Applications for such a license should be addressed to the
SNOMED Terminology Solutions division of the CAP.
Any public dissemination of the original or modified Protocols is prohibited without a written
license from the CAP.
The College of American Pathologists offers these protocols to assist pathologists in providing
clinically useful and relevant information when reporting results of surgical specimen examinations
of surgical specimens. The College regards the reporting elements in the “Surgical Pathology
Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the
pathology report. However, the manner in which these elements are reported is at the discretion
of each specific pathologist, taking into account clinician preferences, institutional policies, and
individual practice.
The College developed these protocols as an educational tool to assist pathologists in the useful
reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement,
or other contexts. Nevertheless, the College recognizes that the protocols might be used by
hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on
Cancer of the American College of Surgeons mandated the use of the checklist elements of the
protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it
becomes even more important for pathologists to familiarize themselves with these documents. At
the same time, the College cautions that use of the protocols other than for their intended
educational purpose may involve additional considerations that are beyond the scope of this
document.
The inclusion of a product name or service in a CAP publication should not be construed as an
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to be construed as disapproval.

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Gastrointestinal • Perihilar Bile Ducts
PerihilarBileDuct 3.0.0.0
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CAP Perihilar Bile Duct Protocol Revision History

Version Code
The definition of the version code can be found at www.cap.org/cancerprotocols.

Version: PerihilarBileDuct 3.0.0.0

Summary of Changes
No changes have been made since the October 2009 release.

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CAP Approved
Gastrointestinal • Perihilar Bile Ducts
PerihilarBileDuct 3.0.0.0

* Data elements with asterisks are not required. However, these elements may be
clinically important but are not yet validated or regularly used in patient management.
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Surgical Pathology Cancer Case Summary (Checklist)

Protocol web posting date: October 2009


PERIHILAR BILE DUCTS: Local or Segmental Resection, Hilar Resection with or
without Hepatic Resection (Note A)

Select a single response unless otherwise indicated.

Specimen (select all that apply)
___ Common bile duct
___ Right hepatic duct
___ Left hepatic duct
___ Junction of right and left hepatic ducts
___ Common hepatic duct
___ Cystic duct

Other Organs Received
___ Liver
___ Gallbladder
___ Other (specify): __________________________________

Procedure
___ Hilar and hepatic resection
___ Segmental resection of bile ducts(s)
___ Choledochal cyst resection (Note B)
___Total hepatectomy
___ Other (specify): ____________________________
___ Not specified

Tumor Site (select all that apply)
___ Right hepatic duct
___ Left hepatic duct
___ Junction of right and left hepatic ducts
___ Cystic duct
___ Common hepatic duct
___ Common bile duct
___ Not specified

Tumor Size
Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined (see “Comment”)

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CAP Approved
Gastrointestinal • Perihilar Bile Ducts
PerihilarBileDuct 3.0.0.0

* Data elements with asterisks are not required. However, these elements may be
clinically important but are not yet validated or regularly used in patient management.
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Histologic Type (Note C)
___ Adenocarcinoma (not otherwise characterized)
___ Papillary adenocarcinoma
___ Mucinous adenocarcinoma
___ Clear cell adenocarcinoma
___ Signet-ring cell carcinoma
___ Adenosquamous carcinoma
___ Squamous cell carcinoma
___ Small cell carcinoma
___ Biliary cystadenocarcinoma
___ Other (specify): ____________________________
___ Carcinoma, not otherwise specified

Histologic Grade (Note D)
___ Not applicable
___ GX: Cannot be assessed
___ G1: Well differentiated
___ G2: Moderately differentiated
___ G3: Poorly differentiated
___ G4: Undifferentiated

Microscopic Tumor Extension (select all that apply)
___ Carcinoma in situ
___ Tumor confined to the bile duct histologically
___ Tumor invades beyond the wall of the bile duct into surrounding connective tissue
___ Tumor invades the adjacent liver parenchyma
___ Tumor invades the gallbladder
___ Tumor invades the unilateral branches of the portal vein (right or left)
___ Tumor invades the unilateral branches of the hepatic artery (right or left)
___ Tumor invades main portal vein or its branches bilaterally
___ Tumor invades common hepatic artery
___ Tumor invades second-order biliary radicals
___ Unilateral
___ Bilateral

Margins (select all that apply) (Note E)
Segmental Resection Specimen
___ Cannot be assessed
___ Margins uninvolved by invasive carcinoma
Distance of invasive carcinoma from closest margin: ___ mm or ___ cm
Specify margin: __________________________
___ Margins involved by invasive carcinoma
___ Proximal bile duct margin
___ Distal bile duct margin
___ Hepatic parenchymal margin
___ Other (specify): _____________________________
___ Dysplasia/carcinoma in situ not identified at bile duct margin
___ Dysplasia/carcinoma in situ present at bile duct margin