Standardised reporting protocol for endoscopic resection for Barrett oesophagus associated neoplasia: expert consensus recommendations

• Published in: Pathology 2014-10, Vol.46 (6), p.473-480
• Main Authors: Kumarasinghe, M.P., Brown, I., Raftopoulos, S., Bourke, M.J., Charlton, A., de Boer, W.B., Eckstein, R., Epari, K., Gill, A.J., Lam, A.K., Price, T., Streutker, C., Lauwers, G.Y.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Consensus; Early oesophageal neoplasia; endoscopic resections; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagoscopy; Esophagus - pathology; Esophagus - surgery; Humans; key prognostic features; Neoplasm Invasiveness; Neoplasm Staging; pathological assessment; Precancerous Conditions - pathology; Precancerous Conditions - surgery; Prognosis; Specimen Handling; standard reporting
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1097/PAT.0000000000000160

Endoscopic resection (ER) is considered the therapy of choice for intraepithelial neoplasia associated with visible lesions and T1a adenocarcinoma. Pathologists are bound to encounter specimens collected via these techniques more frequently in their practice. A standardised protocol for handling, grossing, and assessing ER specimens should be adopted to ensure that all prognostic information and characteristics influencing treatment are included in reports (see Supplementary Video Abstract, http://links.lww.com/PAT/A22). The entire specimen should be appropriately oriented, processed and assessed. An ER specimen will commonly show intraepithelial neoplasia or invasive carcinoma. There are essential features that should be recorded if invasive carcinoma is found as they dictate further management and follow-up. These features are the margin status, depth of invasion, degree of differentiation and presence or absence of lymphovascular invasion. Important features such as duplication of muscularis mucosae should be recognised to avoid misinterpretation of depth of invasion. Key diagnostic and prognostic elements that are essential for optimal clinical decisions have been included in the reporting format proposed by the Structured Pathology Reporting committee of the Royal College of Pathologists of Australasia (RCPA).