Two-tier architecture-based grading for pancreatic cancer outperforms traditional grading

A novel architecture-based grading system for pancreatic ductal adenocarcinoma (PDAC) is tested against traditional grading. A total of 103 PDAC resections were graded by College of American Pathologists/American Joint Committee on Cancer (CAP/AJCC) guidelines and by a system using an architectural pattern (dispersed larger duct = low grade vs dense smaller duct = high grade). Survival analyses and interobserver variability were assessed. In total, 114 cases from a public data set were used for validation. Median overall survivals were 15 and 36 months for architectural high-grade and low-grade cases, respectively (P