Processing of specimens and standardized pathological evaluation of endoscopic submucosal dissection for early gastric cancer and precancerous lesion in 80 cases

Abstract

Objective To study the standardized pathological evaluation of early gastric cancer and precancerous lesions and its significance for endoscopic submucosal dissection(ESD). Methods A total of 80 cases of early gastric cancer and precancerous lesions were collected in the center of endoscopy from July 2012 to September 2015, who were treated by ESD. The pathological diagnosis of all cases before and after ESD was obtained. Specimens were processed and pathologically evaluated according to Japanese gastric cancer treatment guidelines. The diagnostic consistency of ESD with gastric biopsy was determined, and absolute indication, expanded indication, curative resection, and non-curative resection as well. Results There were 9 cases(11.25%) of low grade intraepithelial neoplasia, 41 cases(51.25%) of high grade intraepithelial neoplasia, and 30 cases(37.50%) of early gastric cancer, with 26 cases of differentiated adenocarcinoma and 4 cases of undifferentiated adenocarcinoma. Preoperative biopsy findings were consistent with post-ESD diagnosis, and the consistency was 67.50%. Six cases also showed ulcer, with 2 cases of high grade intraepithelial neoplasia and 4 cases of early gastric cancer. The vertical margins were negative in all 80 cases, while positive horizontal margin was found in 2 cases of high grade intraepithelial neoplasia and 3 cases of early gastric cancer. No vessel invasion was observed in 30 cases of early gastric cancer. Integrated analysis showed that 22 cases met with absolute indication, 8 cases with expanded indication. After ESD, 24 cases were curative resections whereas 6 cases were considered as non-curative resections(the curative rate was 80.00%), 3 non-curative resection cases were treated with further surgery, and the other 3 cases did not relapse after follow-up. Conclusion The standard pathological evaluation and report of ESD specimen objectively reflects the treatment of ESD and plays an important clinical role in the further treatment and comprehensive evaluation of prognosis. Key words: Early gastric cancer; Intraepithelial neoplasia; Endoscopic submucosal dissection; Pathological evaluation