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

Abstract

Background and Aims

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 EGCs.

Methods

We retrospectively investigated 85 EGCs in 82 patients who had undergone endoscopic resection at our hospital from August 2008 to October 2012. EGCs 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 pathologic diagnoses of 68 EGCs (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 vs. 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 clinical implication of 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 EGCs.

This article is protected by copyright. All rights reserved.

http://bit.ly/2COrvWV