Pathologic assessment of endoscopic resection specimens with superficial carcinoma of the esophagus: current practice and practical issues

Ann N Y Acad Sci. 2020 Dec;1482(1):130-145. doi: 10.1111/nyas.14455. Epub 2020 Sep 1.

Abstract

Endoscopic resection (ER) has become the first-line therapy for early esophageal cancer and offers a treatment alternative to surgery, owing to less morbidity and better quality of life. ER techniques include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is faster, simpler, and cheaper than ESD, but limited by its ability to resect lesions larger than 1.5 centimeters. Piecemeal EMR has limitations, including a high local recurrence rate and a suboptimal specimen for an accurate pathologic assessment. ESD, on the other hand, allows en bloc resections with negative (R0) margins, irrespective of lesion size, providing an excellent pathologic specimen, however, is technically challenging with a higher risk of complications. The evaluation of ER specimens in pathology varies slightly from institution to institution. Our review summarizes the current practices and issues in the pathologic assessment of esophageal ER specimens, which highlights the necessity of a systematic approach and standardization of both macroscopic and microscopic evaluation. There is a need for a comprehensive and standardized pathology report that will allow for uniform terminology for endoscopists, surgeons, and pathologists, which, in turn, will result in better treatment guidance.

Keywords: current practices; endoscopic resection; esophagus; pathology assessment.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery*
  • Barrett Esophagus / pathology
  • Endoscopic Mucosal Resection / methods*
  • Esophageal Mucosa / pathology*
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery*
  • Esophageal Squamous Cell Carcinoma / pathology*
  • Esophageal Squamous Cell Carcinoma / surgery*
  • Esophagoscopy / methods
  • Humans
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Treatment Outcome

Supplementary concepts

  • Adenocarcinoma Of Esophagus