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Pathologic assessment of endoscopic resection specimens with superficial carcinoma of the esophagus: current practice and practical issues
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2020-09-01 , DOI: 10.1111/nyas.14455 Esmeralda Celia Marginean 1 , Jain Dhanpat 2
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2020-09-01 , DOI: 10.1111/nyas.14455 Esmeralda Celia Marginean 1 , Jain Dhanpat 2
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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.
中文翻译：
食管浅表癌内镜切除标本的病理评估：当前的实践和实际问题
内窥镜切除术 (ER) 已成为早期食管癌的一线治疗方法，并且由于发病率较低且生活质量较高，提供了一种替代手术的治疗方法。ER 技术包括内镜黏膜切除术 (EMR) 和内镜黏膜下剥离术 (ESD)。EMR 比 ESD 更快、更简单且更便宜，但受限于其切除大于 1.5 厘米病灶的能力。零碎 EMR 具有局限性，包括局部复发率高和用于准确病理评估的次优标本。另一方面，ESD 允许整块切除，边缘为阴性（R0），无论病变大小如何，提供出色的病理标本，但在技术上具有挑战性，并发症风险更高。病理学中 ER 标本的评估因机构而异。我们的综述总结了食管 ER 标本病理评估的当前做法和问题，强调了宏观和微观评估的系统方法和标准化的必要性。需要一份全面和标准化的病理报告，以便为内窥镜医师、外科医生和病理学家提供统一的术语，进而提供更好的治疗指导。
更新日期：2020-09-01
中文翻译：
食管浅表癌内镜切除标本的病理评估：当前的实践和实际问题
内窥镜切除术 (ER) 已成为早期食管癌的一线治疗方法，并且由于发病率较低且生活质量较高，提供了一种替代手术的治疗方法。ER 技术包括内镜黏膜切除术 (EMR) 和内镜黏膜下剥离术 (ESD)。EMR 比 ESD 更快、更简单且更便宜，但受限于其切除大于 1.5 厘米病灶的能力。零碎 EMR 具有局限性，包括局部复发率高和用于准确病理评估的次优标本。另一方面，ESD 允许整块切除，边缘为阴性（R0），无论病变大小如何，提供出色的病理标本，但在技术上具有挑战性，并发症风险更高。病理学中 ER 标本的评估因机构而异。我们的综述总结了食管 ER 标本病理评估的当前做法和问题，强调了宏观和微观评估的系统方法和标准化的必要性。需要一份全面和标准化的病理报告，以便为内窥镜医师、外科医生和病理学家提供统一的术语，进而提供更好的治疗指导。
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