Abstract
ObjectiveIt is always challenging to diagnose and characterize early gastric cancer surrounded by non-cancerous mucosa, including the malignant diagnosis and extent and depth of the lesions. Therefore, we developed a light transmission-assisted pathological examination to diagnose and characterize early gastric cancer. Here, we performed a parallel comparison between the light transmission-assisted pathological examination under endoscopy and the histological examination for the diagnosis of early gastric cancer.MethodsFirst, the endoscopic submucosal dissection (ESD) specimen was first placed on the surface of the light-emitting diode lamp to observe the mucosal surface structure and blood vessels. Second, the sliced and embedded tissue strips were cut into 3-µm sections for hematoxylin and eosin staining. Third, the histopathology of each section was projected onto a macroscopic image. Finally, the macroscopic and microscopic changes in the ESD specimens observed under endoscopy were compared. Seventy cases of early gastric adenocarcinoma were diagnosed and characterized using this new method.ResultsUsing the conventional pathological method, the demarcation line of the lesions was seen in 40 of 70 (57.1%) cases. Furthermore, no surface structure or microvascular changes were observed in any of the cases. Based on the light transmission-assisted pathological examination, 58 of 70 (82.9%) cases presented clear edges of neoplastic and non-neoplastic epithelia, with a classifiable surface structure (88.6%) and microvascular type (78.8%).ConclusionsThis pilot method provided a practical bridge between endoscopic and pathological examinations. Compared to the histological examination, the light transmission-assisted pathological examination was an easier and more precise way to match the in vivo endoscopic observation and in vitro pathological examination.
Highlights
Endoscopic examination of the gastric mucosal surface structure and vascular changes is usually used to diagnose early gastric cancer (EGC)
We developed a new method based on light transmission beneath formalin-fixed Endoscopic submucosal dissection (ESD) specimens to assist pathologists in distinguishing subtle mucosal changes in ESD specimens
The exclusion criteria were as follows: 1) contraindication to gastroscopy; 2) operative contraindications to either coagulopathy or cardiopulmonary resuscitation; 3) women during pregnancy or the lactation period, or women who may not take effective contraceptive measures; 4) patients suffering from other system malignancies at the same time; 5) those unwilling to participate in this research; and 6) ESD specimens with poor fixation
Summary
Endoscopic examination of the gastric mucosal surface structure and vascular changes is usually used to diagnose early gastric cancer (EGC). Endoscopic submucosal dissection (ESD) [1,2,3,4] is a minimally invasive procedure that achieves curative effects for early gastrointestinal cancer [5,6,7]. The evaluation of ESD results depends on the postoperative standardized pathological examination [8]. The ESD specimens shrink after formalin fixation, and the color becomes darker on the mucosal surface, which makes it difficult to clearly define the lesions. An unidentified area of cancer and the difficulty in determining the status of the mucosal resection margin result in an inaccurate pathological diagnosis of ESD specimens [12]
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