摘要：
The recently published 8th edition of American Joint Committee of Cancer(AJCC) staging for ampullary cancer has made dramatic changes in the T and N staging. Quantification of the invasion depth is required for the T staging and N has been subdivided into N1 and N2 based on the number of positive lymph nodes. Standardization of pathology sampling and reporting is demanded. For the precise staging, adequate exposure and fixation of the ampullary region before sampling is a critical step. It is important to take the sections parallel to the common bile and perpendicular to the ampullary mucosa, with an interval of 0.5 cm, to make sure that the ampullary region, pancreas and duodenum on the same plane. At least 12 lymph nodes are required. The pathology report should provide information regarding the specimen type, the position, size, differentiation, histopathology, infiltration, margin, lymph node metastasis, vasculature involvement and the results of specialized staining of the tumor. These updates are based on novel evidence, emphasizing the importance of the measurable objective parameters, reflecting the deeper understanding on ampullary cancer.%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.
