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近期发布的美国癌症联合委员会(AJCC)第8版壶腹部癌分期系统在T分期和N分期上进行了较大的修订。T分期明确量化了壶腹部癌侵犯周围组织的范围,N分期则根据淋巴结转移数目分为N1和N2。从而对于病理学取材及报告的规范提出了更高的要求。为进行准确分级,病理学标本取材前需将壶腹部解剖结构进行充分的暴露和固定,取材时须要垂直于壶腹部黏膜,沿胆总管走向,做间隔0.5 cm的剖开,确保壶腹部黏膜、胰腺及十二指肠肠壁在同一蜡块上,才可清楚观察到肿瘤的浸润深度,从而进行准确分级。淋巴结数量要达到12枚。病理学报告中应该包括以下内容:标本类型及大体改变、肿瘤大小、分化程度、组织亚型、浸润范围、切缘情况、淋巴结情况、血管及淋巴管的侵犯以及必要的特殊检查结果。AJCC第8版分期系统相较于第7版,分期更细,定义更为清晰,判断标准更突出可测量的客观性指标。
The recently released AJCC 8th edition of the ampullary cancer staging system undergoes a major revision in both T-staging and N-staging. T staging clearly quantify the scope of the surrounding tissue of the ampulla carcinoma, N stage is divided into N1 and N2 according to the number of lymph node metastasis. Which put forward higher requirements for the specification of pathology drawing and reporting. For accurate grading, the ampulla anatomical structure should be adequately exposed and fixed before the pathological specimen is drawn. The material should be perpendicular to the ampulla mucosa and follow the direction of the common bile duct to make a 0.5 cm dissection to ensure that the ampulla mucosa, Pancreatic and duodenal wall in the same wax block, we can clearly observe the depth of invasion of the tumor, so as to accurately grading. The number of lymph nodes to reach 12. Pathology report should include the following: specimen type and general change, tumor size, degree of differentiation, tissue subtype, infiltration range, margins, lymph nodes, blood vessels and lymphatic vessels and the necessary special examination results. Compared with the seventh edition of the AJCC Eighth Edition, the phased system has a more detailed definition and clearer definition, and the more prominent the judgment criterion is the measurable objectivity index.