Pathological assessment of endoscopic resections of the gastrointestinal tract: a comprehensive clinicopathologic review

  • A Correction to this article was published on 14 January 2020

Abstract

Endoscopic resection (ER) allows optimal staging with potential cure of early-stage luminal malignancies while maintaining organ preservation. ER and surgery are non-competing but complementary therapeutic options. In addition, histological examination of ER specimens can either confirm or refine the pre-procedure diagnosis. ER is used for the treatment of Barrett's related early carcinomas and dysplasias, early-esophageal squamous cell carcinomas and dysplasias, early gastric carcinomas and dysplasia, as well as low-risk submucosal invasive carcinomas (LR-SMIC) and, large laterally spreading adenomas of the colon. For invasive lesions, histological risk factors predict risk of lymph node metastasis and residual disease at the ER site. Important pathological risk factors predictive of lymph node metastasis are depth of tumor invasion, poor differentiation, and lymphovascular invasion. Complete resection with negative margins is critical to avoid local recurrences. For non-invasive lesions, complete resection is curative. Therefore, a systematic approach for handling and assessing ER specimens is recommended to evaluate all above key prognostic features appropriately. Correct handling starts with pinning the specimen before fixation, meticulous macroscopic assessment with orientation of appropriate margins, systematic sectioning, and microscopic assessment of the entire specimen. Microscopic examination should be thorough for accurate assessment of all pathological risk factors and margin assessment. Site-specific issues such as duplication of muscularis mucosa of the esophagus, challenges of assessing ampullectomy specimens and site-specific differences of staging of early carcinomas throughout the gastrointestinal tract (GI) tract should be given special consideration. Finally, a standard, comprehensive pathology report that allows optimal staging with potential cure of early-stage malignancies or better stratification and guidance for additional treatment should be provided.

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Fig. 7: T1a adenocarcinoma of esophagus with further subdivision according to the depth pf invasion.
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Fig. 11: Endoscopic submucosal dissection of colorectal adenocarcinoma with tumor at inked deep margin (“involved”, indicated by arrows).

Change history

  • 09 January 2020

    The original version of this Article has been updated and the changes are shown in the related Correction article.

  • 14 January 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Acknowledgements

We thank the Rodger C. Haggitt Gastrointestinal Pathology Society and Australasian Gastrointestinal Pathology Society (and their leadership) for the opportunity and support in developing these guidelines.

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Correspondence to M. Priyanthi Kumarasinghe.

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Kumarasinghe, M.P., Bourke, M.J., Brown, I. et al. Pathological assessment of endoscopic resections of the gastrointestinal tract: a comprehensive clinicopathologic review. Mod Pathol (2020). https://doi.org/10.1038/s41379-019-0443-1

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