Optimizing histopathologic evaluation of EMR specimens of Barrett’s esophagus–related neoplasia: a randomized study of 3 specimen handling methods

Overwater, Anouk; Meulen, Kim E. van der; Künzli, Hannah T.; Schoon, Erik J.; Bergman, Jacques; Raicu, G.; Seldenrijk, Kees A.; Weusten, Bas L.

doi:10.1016/j.gie.2019.03.014

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…This method, first introduced in Japan, is currently practised in Europe, Canada, East Asia and Australasia and in some centres in the United States. 89,90,[93][94][95][96][97] A study performed by a Dutch group comparing the pinning and non-pinning methods failed to demonstrate a statistically significant difference, but the number of cases was small. 94 The approach to sectioning of endoscopic resection depends upon the macroscopic appearance and the size of the specimens.…”

Section: Pathological Assessment Of Endoscopic Resectionsmentioning

confidence: 99%

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

et al. 2020

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Modern management of Barrett’s oesophagus and related neoplasia essentially focuses upon surveillance to detect early low‐risk neoplastic lesions and offering organ‐preserving advanced endoscopic therapies, while traditional surgical treatments of oesophagectomy and lymph node clearance with or without chemoradiation are preserved only for high‐risk and advanced carcinomas. With this evolution towards figless invasive therapy, the choice of therapy hinges upon the pathological assessment for risk stratifying patients into those with low risk for nodal metastasis who can continue with less invasive endoscopic therapies and others with high risk for nodal metastasis for which surgery or other forms of treatment are indicated. Detection and confirmation of neoplasia in the first instance depends upon endoscopic and pathological assessment. Endoscopic examination and biopsy sampling should be performed according to the recommended protocols, and endoscopic biopsy interpretation should be performed applying standard criteria using appropriate ancillary studies by histopathologists experienced in the pathology of Barrett’s disease. Endoscopic resections (ERs) are both diagnostic and curative and should be performed by clinicians who are skilled with advanced endoscopic techniques. Proper preparation and handling of ERs are essential to assess histological parameters that dictate the curative nature of the procedure. Those parameters are adequacy of resection and risk of lymph node metastasis. The risk of lymph node metastasis is determined by depth invasion and presence of poor differentiation and lymphovascular invasion. Those adenocarcinomas with invasion up to muscularis mucosae (pT1a) and those with superficial submucosal invasion (pT1b) up to 500 µ with no poor differentiation and lymphovascular invasion and negative margins may be considered cured by endoscopic resections.

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Section: Pathological Assessment Of Endoscopic Resectionsmentioning

confidence: 99%

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

et al. 2020

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“…A Dutch group compared the three methods by prospectively randomizing 126 EMR specimens from 42 patients for each grossing method, after excluding the specimens clinically suspicious for submucosal invasion. 27 No ESD specimens were included in the study. Their primary outcome was to compare an "optimal overall histopathologic evaluation score," which included the ability to discern the lateral from the deep margin, assess the deep margin status, the depth of invasion, tumor grade, and the presence of lymphovascular invasion (LVI).…”

Section: The Cassette Technique: This Is a Techniquementioning

confidence: 99%

Section: Pathologic Evaluation Of Er Specimensmentioning

confidence: 99%

Pathologic assessment of endoscopic resection specimens with superficial carcinoma of the esophagus: current practice and practical issues

Marginean

Jain

2020

Annals of the New York Academy of Sciences

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Endoscopic resection (ER) has become the first-line therapy for early esophageal cancer and offers a treatment alternative to surgery, owing to less morbidity and better quality of life. ER techniques include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is faster, simpler, and cheaper than ESD, but limited by its ability to resect lesions larger than 1.5 centimeters. Piecemeal EMR has limitations, including a high local recurrence rate and a suboptimal specimen for an accurate pathologic assessment. ESD, on the other hand, allows en bloc resections with negative (R0) margins, irrespective of lesion size, providing an excellent pathologic specimen, however, is technically challenging with a higher risk of complications. The evaluation of ER specimens in pathology varies slightly from institution to institution. Our review summarizes the current practices and issues in the pathologic assessment of esophageal ER specimens, which highlights the necessity of a systematic approach and standardization of both macroscopic and microscopic evaluation. There is a need for a comprehensive and standardized pathology report that will allow for uniform terminology for endoscopists, surgeons, and pathologists, which, in turn, will result in better treatment guidance.

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“…The latter can stem from complicated tables concerning obscure genes that govern inflammatory pathways that interact with bacteria, tedious immunologic data, and metabolic novelties that boggle the mind. However, in this issue of Gastrointestinal Endoscopy, Overwater et al 1 have provided us with a breath of fresh air.…”

mentioning

confidence: 99%

“…3 Ancillary techniques can be used to search for vascular space invasion and to better define the layers of the mucosa, and they can be helpful. In our own pathology practice, we do not routinely add ancillary immunostaining, as was done by Overwater et al, 1 and it is not clear whether such staining is routine in the practices of the pathologists who conducted the study.…”

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confidence: 99%

The beauty of simplicity

Montgomery

2019

Gastrointestinal Endoscopy

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Optimizing histopathologic evaluation of EMR specimens of Barrett’s esophagus–related neoplasia: a randomized study of 3 specimen handling methods

Cited by 9 publications

References 25 publications

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

Pathologic assessment of endoscopic resection specimens with superficial carcinoma of the esophagus: current practice and practical issues

The beauty of simplicity

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