Recent WHO-based classifications and the 2025 PERIPAN consensus emphasize determining the epicenter and compartment of the precursor lesion to establish the origin of the subsequent carcinoma give reference of above statement
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"PERIPAN" consensus 2025 precursor lesion carcinoma epicenter compartment
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PERIPAN consensus carcinoma
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"precursor lesion" carcinoma epicenter
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PMID: 40729532
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https://onlinelibrary.wiley.com/doi/full/10.1002/ueg2.70074
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WHO classification ampullary carcinoma epicenter precursor lesion intra-ampullary ampullary ductal periampullary duodenal
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PMID: 40729532
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ampullary carcinoma classification Adsay
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https://pmc.ncbi.nlm.nih.gov/articles/PMC10741460/
A suitable reference for that statement is the 2025 PERIPAN consensus guideline:
Abu Hilal M, Uijterwijk BA, Lemmers DHL, et al. The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN). United European Gastroenterology Journal. 2025;13(7):1048-1068. doi:10.1002/ueg2.70074. PMID: 40729532. The guideline states that classification should be based on the gross-microscopic correlation of the tumor (epi)center and any relevant precursor lesion, and defines precursor lesions according to their epicenter within specific ampullary compartments. Full PERIPAN guideline
For the WHO-based component, you can cite:
Tsagkalidis V, et al. Ampullary adenocarcinoma: A review of the mutational landscape and implications for treatment. Cancers (Basel). 2024;16(2):[article details]. This review summarizes the WHO approach: ampullary tumors are defined by an epicenter in the ampullary region, determined on gross examination of the resection specimen. WHO classification summary
A more precise, manuscript-ready phrasing would be:
“WHO-based anatomic classification and the 2025 PERIPAN consensus recommend establishing the primary site of ampullary-region carcinoma through gross-microscopic assessment of the tumor epicenter and the location of any associated precursor lesion within the relevant anatomic compartment.” PERIPAN consensus
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