Impact of examining additional deeper sections on the pathological diagnosis of endoscopically resected early gastric cancer

Abstract

Objectives The pathological diagnosis of endoscopically resected early gastric cancer (EGC) is performed by evaluating a few representative sections from the specimen. We aimed to determine whether evaluating twice as many sections as usual by essentially cutting the original sections in half could improve the pathological diagnosis of EGC. Methods We retrospectively investigated 85 EGC in 82 patients who had undergone endoscopic resection at our hospital from August 2008 to October 2012. EGC without indications of curative resection were excluded. We re‐examined the original paraffin blocks after shaving away approximately half their original thickness, and evaluated whether the pathological diagnoses were affected. This technique essentially doubled the number of sections examined. Results Ten pathological diagnoses of 68 EGC (14.7%) were changed from curative resection to non‐curative resection when we evaluated twice as many sections as in the standard method. The median tumor size was 25 mm in the changed diagnosis group versus 14.5 mm in the no change group (P = 0.03). The univariate analysis also showed that tumor size was a significant predictor of changed diagnosis (P = 0.015). Both the changed diagnosis group and no change group had no recurrence during follow up. Conclusions Histological evaluation of twice as many sections as usual changed the initial pathological diagnosis of EGC, although the clinical implication of an additional deeper section was controversial because there was no recurrence. Our analysis also emphasized the importance of detailed histological evaluation to confirm a radical cure in endoscopic resection, especially in the case of larger EGC.

Relationship between histological mixed-type early gastric cancer and lymph node metastasis: A systematic review and meta-analysis

“…If the lesion fulfills the absolute indication for ESD, it is considered eCura A; if it fulfills the expanded indication or includes differentiated cancer measuring �3 cm with a submucosal invasion depth of SM1, it is considered eCura B. A lesion not meeting the above criteria is considered eCura C. Follow-up with esophagogastroduodenoscopy and an ultrasonography or computed tomography scan to detect metastases is recommended at intervals of 6-12 months for patients with eCura A and B lesions because of their negligible LNM risk [21,22].…”

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

“…). However, it should be noted that 14.7% of these curability cases changed to eCura C‐2 when re‐evaluating the pathology using additional deeper sections …”