{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:58:56Z","timestamp":1778086736155,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Accurate determination of tumour size is critical for pT staging in pancreatic ductal adenocarcinoma (PDAC), yet gross measurement alone often underestimates the true tumour extent because of the tumour's ill\u2010defined and infiltrative nature. This study aimed to evaluate the diagnostic and prognostic value of incorporating microscopic rectification into tumour size assessment in PDAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      A total of 342 therapy\u2010na\u00efve pancreatoduodenectomies were analysed using a grossing protocol that includes separate sampling of anterior and posterior soft tissues via the \u2018orange\u2010peeling\u2019 technique to retrieve lymph nodes and document soft tissue involvement. Peripancreatic soft tissue involvement was present in 91% of cases, and isolated microscopic foci distant from the main mass in 48%. Of the 266 tumours grossly classified as pT1\/T2 (\u22644\u2009cm), 39 (14%) showed carcinoma in both anterior and posterior soft tissues, and were reclassified as pT3. This subset showed significantly worse survival (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04) and higher nodal positivity (87% versus 69%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02) than the remaining pT2 cases, comparable to conventional pT3 tumours (86%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.77). Multivariable Cox regression adjusted for age, sex, nodal status, margin, and lymphovascular\/perineural invasion confirmed the survival disadvantage of this subgroup. Reclassification yielded a more balanced distribution of T categories (pT2 66%\u2009\u2192\u200952%, pT3 22%\u2009\u2192\u200934%) and modestly improved prognostic discrimination (C\u2010index: 0.592 versus 0.574).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study elucidates that PDAC frequently extends beyond the visible mass (\u2018horses out of the barn\u2019 phenomenon); peripancreatic soft tissue involvement is common, and gross size often underestimates the true tumour extent, making microscopic correction crucial. Approximately one in six pT1\/T2 tumours (\u22644\u2009cm) shows carcinoma in both anterior and posterior soft tissues and behave like pT3 in outcomes and nodal status. Therefore, gross\u2010micro rectification is essential to avoid understaging, particularly for T2 tumours. The orange\u2010peeling protocol should classify tumours with foci in both anterior and posterior soft tissues as pT3, while other approaches may employ mapping techniques to enable microscopic reconstruction and biologically accurate staging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70099","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:15:21Z","timestamp":1769516121000},"page":"1385-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cHorses out of the barn\u201d: pancreatic ductal adenocarcinoma frequently extends beyond the grossly visible tumour, requiring microscopic rectification for accurate T\u2010staging"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2043-2041","authenticated-orcid":false,"given":"Burcu","family":"Saka","sequence":"first","affiliation":[{"name":"Department of Pathology Ko\u00e7 University School of Medicine  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8809-5846","authenticated-orcid":false,"given":"Bahar","family":"Memis","sequence":"additional","affiliation":[{"name":"Department of Pathology Kocaeli University Faculty of Medicine  Kocaeli Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7852-3851","authenticated-orcid":false,"given":"Serdar","family":"Balci","sequence":"additional","affiliation":[{"name":"Department of Pathology Memorial Health Group  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0397-3583","authenticated-orcid":false,"given":"Ipek","family":"Erbarut Seven","sequence":"additional","affiliation":[{"name":"Department of Pathology Marmara University Faculty of Medicine  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6535-8845","authenticated-orcid":false,"given":"Burcin","family":"Pehlivanoglu","sequence":"additional","affiliation":[{"name":"Department of Pathology Dokuz Eyl\u00fcl University Faculty of Medicine  Izmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6656-8227","authenticated-orcid":false,"given":"Pelin","family":"Bagci","sequence":"additional","affiliation":[{"name":"Botton\u2010Champalimaud Pancreatic Cancer Center  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9426-3500","authenticated-orcid":false,"given":"Rohat","family":"Esmer","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5046-7536","authenticated-orcid":false,"given":"Zeynep","family":"Tarcan","sequence":"additional","affiliation":[{"name":"Department of Pathology Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanette D","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Pathology Piedmont Hospital  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3591-8925","authenticated-orcid":false,"given":"Shishir K","family":"Maithel","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine  Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-0455","authenticated-orcid":false,"given":"David A","family":"Kooby","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1874-6658","authenticated-orcid":false,"given":"Juan","family":"Sarmiento","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University School of Medicine  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2661-5746","authenticated-orcid":false,"given":"Bassel","family":"El\u2010Rayes","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center University of Alabama at Birmingham, Heersink School of Medicine  Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3812-4098","authenticated-orcid":false,"given":"Michelle D","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Pathology Emory University School of Medicine  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2747-1366","authenticated-orcid":false,"given":"Olca","family":"Basturk","sequence":"additional","affiliation":[{"name":"Department of Pathology Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1308-3701","authenticated-orcid":false,"given":"N Volkan","family":"Adsay","sequence":"additional","affiliation":[{"name":"Department of Pathology Ko\u00e7 University School of Medicine  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5093-7"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3"},{"key":"e_1_2_9_4_1","volume-title":"TNM classification of malignant tumours","author":"Harmer MH","year":"1982"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.3617"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002531"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2014.06.030"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4160-3256-4.50064-8"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.path.2011.03.004"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2012.08.010"},{"key":"e_1_2_9_11_1","unstructured":"College of American Pathologists (CAP).Protocol for the examination of specimens from patients with carcinoma of the pancreas.2025. Available from:https:\/\/documents.cap.org\/protocols\/cp\u2010pancreas\u201025\u20100601.pdf."},{"key":"e_1_2_9_12_1","unstructured":"College of American Pathologists (CAP).Protocol for the examination of resection specimens from patients with invasive carcinoma of the breast.2024. Available from:https:\/\/documents.cap.org\/protocols\/Breast.Invasive_4.10.0.0.REL.CAPCP.pdf."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2015.74"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31826399d8"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2016.125"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2008.167"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000165"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001853"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181908e42"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2019.1607294"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac018"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000887"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14067"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000000520"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2014.08.004"},{"key":"e_1_2_9_26_1","unstructured":"Annual Meeting of the Association of Directors of Anatomic and Surgical Pathology (ADASP) Visibility of Anatomic Pathology and Impact of Diagnoses.2022Available from:https:\/\/www.adasp.org\/meetings\/2022\u2010annual\u2010meeting."},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-022-03495-4"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-025-16917-6"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0307876"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znad146"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2016-0626-CP"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.5858\/133.10.1515"},{"issue":"3","key":"e_1_2_9_33_1","first-page":"1457","article-title":"Sagittal (duct\u2010centric) grossing of Whipple specimens as a novel approach that combines the benefits of the axial and Bivalving methods and provides more detailed documentation of anatomic variations and pathologic conditions: radiologic\u2010pathologic correlative analysis of 61 cases","volume":"103","author":"Tezcan N","year":"2023","journal-title":"Lab. Investig."},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics9040132"}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70099","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/his.70099","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70099","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T01:08:48Z","timestamp":1777511328000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.70099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/his.70099"],"URL":"https:\/\/doi.org\/10.1111\/his.70099","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]},"assertion":[{"value":"2025-10-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}