Evidence map›Paper›PMID 41724188›Full record

ReviewHistopathology2026

Changes in the 6th edition of the World Health Organization classification of tumours of the digestive system.

Mark J Arends, Irene Esposito, Anthony J Gill, Ralph H Hruban, Joseph D Khoury, Motohiro Kojima, Elizabeth A Montgomery, Fatimah Abdulkareem, Fátima Carneiro, Guido Costamagna and 20 more

Abstract readReview
In one paragraph

Review in Histopathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Review
  2. Review
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

30 authors.

Mark J ArendsEdinburgh Pathology, Institute of Genetics & Cancer, University of Edinburgh, Edinburgh, UK.ORCID https://orcid.org/0000-0002-6826-8770
Irene EspositoInstitute of Pathology, Heinrich Heine University and University Hospital of Dusseldorf, Düsseldorf, Germany.ORCID https://orcid.org/0000-0002-0554-2402
Anthony J GillNSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital St Leonards, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0002-9447-1967
Ralph H HrubanDepartments of Pathology and Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0003-4554-5672
Joseph D KhouryDepartment of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, Omaha, Nebraska, USA.ORCID https://orcid.org/0000-0003-2621-3584
Motohiro KojimaDepartment of Surgical Pathology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
Elizabeth A MontgomeryDepartment of Pathology, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.ORCID https://orcid.org/0000-0001-9788-8218
Fatimah AbdulkareemDepartment of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria.ORCID https://orcid.org/0000-0001-9626-5086
Fátima CarneiroIpatimup/i3S, Faculdade de Medicina da Universidade do Porto and Unidade Local de Saúde São João, Porto, Portugal.ORCID https://orcid.org/0000-0002-1964-1006
Guido CostamagnaCentre of Excellence of Gastrointestinal and Endocrine Metabolic Diseases, Ospedale Isola Tiberina - Gemelli, Rome, Italy.
Gregory LauwersDepartment of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.ORCID https://orcid.org/0000-0002-0897-5385
Alexandros D PolydoridesDepartment of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.ORCID https://orcid.org/0000-0001-8604-0756
Guido RindiSection of Anatomic Pathology, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore - Unit of Anatomic Pathology, Department of Laboratory and Hematological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.ORCID https://orcid.org/0000-0003-2996-4404
Massimo RuggePathology and Cytopathology Unit, University of Padova, Padova, Italy.
Peter SchirmacherInstitute of Pathology, University Hospital, Heidelberg University, Heidelberg, Germany.
Amitabh SrivastavaDepartment of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.ORCID https://orcid.org/0000-0001-5165-8142
James YaoGastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Jennelle C HodgeDepartment of Medical and Molecular Genetics, and IU Simon Comprehensive Cancer Center, Indiana University, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0002-1770-4042
James G KenchSydney Medical School, University of Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0001-8687-4988
Bharat RekhiDepartment of Pathology, Tata Memorial Centre, Mumbai, India.ORCID https://orcid.org/0000-0002-3509-4794
Miguel Reyes-MúgicaDepartment of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.ORCID https://orcid.org/0000-0001-5698-3702
Antonia R SepulvedaDepartment of Pathology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
Chanjuan ShiDepartment of Pathology, Duke University Medical Center, Durham, North Carolina, USA.ORCID https://orcid.org/0000-0001-5962-6479
Pavitratha PuspanathanInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.ORCID https://orcid.org/0000-0001-8672-0022
Harshima WijesingheInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.ORCID https://orcid.org/0000-0002-2847-1440
Christine GiesenInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.ORCID https://orcid.org/0000-0002-5026-9724
Blanca Iciar Indave RuizInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.ORCID https://orcid.org/0000-0003-0259-4781
Dilani LokuhettyInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.ORCID https://orcid.org/0000-0002-4275-3436
WCT standing editorial boardInternational Agency for Research on Cancer, World Health Organisation, Lyon, France.
Iris D NagtegaalDepartment of Pathology, Radboudumc, Nijmegen, the Netherlands.ORCID https://orcid.org/0000-0003-0887-4127

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI SELWYN M VICKERS · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

The 6th Edition of the WHO Classification of Digestive System Tumours represents a significant update to the 5th edition. It integrates pathological, new molecular, and clinical insights to refine the taxonomy of digestive system neoplasms. The revised classification continues to emphasise standardisation in terminology, coding, and diagnostic criteria to facilitate global consistency in diagnosis, treatment, epidemiological reporting and research. Structural reorganisation of book chapters describes epithelial tumours by anatomical site, while separating neuroendocrine, mesenchymal and haematolymphoid tumours into dedicated chapters that are aligned with other WHO tumour volumes. Genetic tumour syndromes are classified by mechanisms, pathways and genes, whereas metastatic disease is comprehensively covered under other tumours and metastases. Key structural and diagnostic refinements include consolidation of gastric dysplasia entities; separation of duodenal/ampullary from jejuno-ileal tumours; clearer categorisation of colorectal serrated polyps and novel carcinoma grading; introduction of small- and large-duct intrahepatic cholangiocarcinoma as separate entities, and redefinition of undifferentiated carcinoma to include 'carcinoma with mesenchymal differentiation'. Several new entities are introduced, including oesophageal epidermoid metaplasia, colorectal intramucosal adenocarcinoma, low-grade tubuloglandular adenocarcinoma and lymphoglandular complex-like adenocarcinoma, intraductal tubulopapillary and intraductal oncocytic papillary neoplasms of the bile ducts and sonic hedgehog hepatocellular adenoma. The concept of amphicrine-like carcinoma (ALC) is distinguished from MiNEN and broadens the understanding of tumours with dual neuroendocrine-non-neuroendocrine differentiation. Grading systems are simplified to two-tier classifications (low/high grade) across precursor lesions, with enhanced criteria for neuroendocrine tumour grading. Anal canal neoplasia terminology is harmonised with human papillomavirus (HPV) related Lower Anogenital Squamous Terminology (LAST) and mass-forming biliary and gallbladder cancer precursors share similar terminology. Finally, carcinoma of unknown primary (CUP) is included in a separate section for the first time, classified by molecular and immunophenotypic profiles to guide therapy. Overall, the 6th edition strengthens tumour diagnostic precision and molecular alignment across the digestive system.

Indexed as

Digestive System NeoplasmsHumansWorld Health Organizationbiliary systemclassificationdigestive systemgastrointestinalliverneoplasmpancreastumour

Identifiers

PMID41724188
PMCPMC13128328

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.