Proper pathologic preparation and assessment of endoscopic mucosal resection and endoscopic submucosal dissection specimens

The application of standardized protocol by pathologists for handling, grossing, and assessing endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) specimens is critical for accurate diagnosis. To best analyze the specimen, several factors, such as maintenance of proper orientation, meticulous macroscopic examination, accurate mapping of the lesion, and appropriate morphologic diagnosis, must be considered. In Japan, general guidelines in the reporting of endoscopic, pathologic, and surgical findings of patients with gastrointestinal cancers have been used for more than 3 decades. More recently, similar universal guidelines have been developed, including the Paris and Vienna classifications, for clinical and pathologic findings, respectively. The WHO Classification of Tumors of the Digestive System (4th edition) can also provide a standardized method to classify pathologic diagnosis. These guidelines provide common terminology for the endoscopists, surgeons, and pathologists to communicate. The standard of practice for EMR and ESD reporting should always include the macroscopic diagnosis, size of the lesion, differentiation, associated findings (ie, gastritis), depth of invasion, presence of peptic ulcer or scar of a stomach lesion, margin status (horizontal and vertical), and lymphovascular/venous invasion because these features are relevant to prognosis and additional treatment decisions.