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Yu Z, Jiang D, Huang W, Luo R, Wang H, Su J, Liu J, Xu C, Hou Y. Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens. J Clin Pathol 2023; 76:757-762. [PMID: 37852629 DOI: 10.1136/jcp-2022-208491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
AIMS Accurate histopathological evaluation of the endoscopic submucosal dissection (ESD) specimens is essential for clinicians to guide further triage and management. This study aimed to report a novel processing technique for large ESD (≥4 cm) specimens. METHODS 92 patients with colorectal neoplasms who had undergone ESD were included. 46 ESD specimens were treated with conventional handling process, while the rest 46 cases were given the optimised method. Macrobiocassettes and L-shaped embedding moulds were applied in the optimised method. We evaluated the efficacy of this improved procedure in terms of the number of paraffin blocks, storage space and time consumption of pathological assessment. RESULTS The average diameter of ESD specimens was 4.5±0.4 cm and 4.7±0.5 cm in the control and test group (p=0.023), respectively. In control group, 398 paraffin blocks of 46 cases were obtained. With the same cases number and larger lesion size, only 276 blocks were achieved in test group (p<0.001). As for the storage space, the total volume of paraffin blocks and slides (4554.0 cm3 and 1207.5 cm3) of optimised method was significantly reduced compared with the control group (6208.8 cm3 and 1741.3 cm3) (p=0.001, p<0.001). In addition, the optimised method was superior to the conventional one in shortening time consumption of pathological assessment (164.5 min and 269.0 min, p<0.001). CONCLUSIONS The optimised technique not only reduced the workload and storage space, but also facilitated accurate pathological assessment.
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Affiliation(s)
- Zixiang Yu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wen Huang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Haixing Wang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jieakesu Su
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jia Liu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pathology, School of Basic Medical Sciences & Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Pathology, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, Fujian, China
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Maselli R, Spadaccini M, Belletrutti PJ, Galtieri PA, Attardo S, Carrara S, Anderloni A, Fugazza A, Ferrara EC, Pellegatta G, Iannone A, Hassan C, Repici A. Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence. Endosc Int Open 2022; 10:E127-E134. [PMID: 35047343 PMCID: PMC8759944 DOI: 10.1055/a-1551-3058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022] Open
Abstract
Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60-76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence.
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Affiliation(s)
- Roberta Maselli
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | - Paul J. Belletrutti
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
| | | | - Simona Attardo
- Gastroenterology Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Silvia Carrara
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Andrea Anderloni
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Alessandro Fugazza
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Elisa Chiara Ferrara
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Gaia Pellegatta
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy
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