• Mohamedraed Elshami, Alwalid K Ammoun, Wadad S Mneimneh, Henry J Stitzel, Jonathan J Hue, Victoria S Wu, Ravi K Kyasaram, John Shanahan, Tashinga Musonza, John B Ammori, Jeffrey M Hardacre, Jordan M Winter, Mohamed ElHag, and Lee M Ocuin.
• Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
• Ann. Surg. 2023 Dec 1; 278 (6): e1204e1209e1204-e1209.

ObjectiveTo assess the frequency of occult metastases (OM) in patients with resected pancreatic ductal adenocarcinoma (PDAC) or ampullary adenocarcinoma (AA) discovered on detailed pathologic examination on lymph nodes (LNs) previously considered negative by conventional analysis and to examine the association between OM and overall survival (OS).BackgroundPoor prognosis of patients with no pathologic evidence of LN metastases may be due to OM that is not detected on conventional LN analysis.MethodsPatients with LN-negative resected PDAC or AA (2010-2020) were identified from our institutional database. Original hematoxylin and eosin ( H and E ) slides were reanalyzed. In addition, selected LN were analyzed by H and E (3 sections/LN) and pan-cytokeratin (AE1-AE3/PCK26) immunohistochemistry.ResultsA total of 598 LNs from 74 LN-negative patients were reexamined. Nineteen patients (25.7%) had OM; 9 (47.4%) were found with immunohistochemistry but not on H and E . The number of positive LNs ranged from 1 to 3. No clinicodemographic, pathologic, or treatment-related factors were associated with OM. On conventional LN analysis, 3/19 patients (15.8%) had stage IA, 9/34 (26.5%) had stage IB, and 7/19 (36.8%) had stage IIA. On detailed LN analysis, 11/19 patients (57.9%) were upstaged to IIB, whereas 8/19 (42.1%) had isolated tumor cells only (N0i+). OM was associated with shorter OS (median OS: 22.3 vs 50.5 months; hazard ratio=3.95, 95% CI: 1.58-9.86).ConclusionsThere is a 26% discordance rate between conventional and detailed LN pathologic analysis in resected PDAC and AA. The presence of OM is associated with shorter OS.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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