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- Title
Endoscopie Mucosal Resection (EMR) In Barrett's Esophagus Associated Neoplasia: Recommendations For Pathological Evaluation And Reporting.
- Authors
Muir, Jennifer A.; Marcon, Norman; Aranda-Hernandez, Javier; Cirocco, Maria; Al-Haddad, Sahar; Streutker, Catherine J.; Grin, Andrea
- Abstract
Endoscopic mucosal resection (EMR) is a minimally-invasive technique increasingly adopted for resection of superficial neoplasia arising in Barrett's esophagus (BE). High-grade dysplasia or adenocarcinoma confined to the mucosa (pTla) should be treated by EMR rather than esophagectomy, as this has been shown to attain similar long-term survival with lower immediate morbidity and mortality rates. As the prevalence of BE continues to rise and gastroenterologists gain comfort with EMR, it is likely that pathologists in both academic and community settings will evaluate more EMR specimens in the future. Accurate assessment of EMR specimens depends upon appropriate macroscopic handling and microscopic diagnosis. Specimens should be pinned flat prior to fixation and the margins should be inked with a vivid colour both to help orient the fragments during embedding and for assessment of their relationship to invasive lesions. The specimen should then be serially sectioned at 2 mm intervals and submitted sequentially for histological evaluation. Microscopic assessment should include the histological type, grade, stage, tumour size, margin status, and distance of carcinoma from the margin, as well as the presence or absence of lymphovascular invasion and tumour budding. Depth of invasion should be reported according to the AJCC 7th edition or the Vieth and Stolte system with special attention paid to the frequent finding of a duplicated muscularis mucosae. Evaluation of EMR specimens according to these recommendations will allow consistency among pathologists and ensure that patient prognosis and treatment decisions are based on complete and accurate information.
- Subjects
BARRETT'S esophagus; MUCOUS membranes; ENDOSCOPIC surgery; ESOPHAGECTOMY; SURVIVAL analysis (Biometry); SURGERY; THERAPEUTICS
- Publication
Canadian Journal of Pathology, 2015, Vol 7, Issue 4, p25
- ISSN
1918-915X
- Publication type
Article