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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

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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.

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Acknowledgments

This study was supported by the BONFOR program of the Bonn University Medical Faculty.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Bonn, Bonn, Germany

    Hanno Matthaei, Philipp Lingohr, Simone Glees, Martin Roering, Pauline Möhring, Martin Scheerbaum, Burkhard Stoffels, Jörg C. Kalff & Nico Schäfer

  2. Institute of Pathology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Anke Strässer, Dimo Dietrich, Babak Rostamzadeh & Glen Kristiansen

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  1. Hanno Matthaei
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  2. Philipp Lingohr
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  3. Anke Strässer
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  13. Glen Kristiansen
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Corresponding author

Correspondence to Glen Kristiansen.

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Hanno Matthaei, Philipp Lingohr, and Anke Strässer have equal contributions.

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Matthaei, H., Lingohr, P., Strässer, A. et al. Biliary intraepithelial neoplasia (BilIN) is frequently found in surgical margins of biliary tract cancer resection specimens but has no clinical implications. Virchows Arch 466, 133–141 (2015). https://doi.org/10.1007/s00428-014-1689-0

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  • DOI: https://doi.org/10.1007/s00428-014-1689-0

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