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    Oesophageal endoscopic mucosal resection

    Background

    Endoscopic procedures are undertaken to resect pre-malignant and malignant lesions of the oesophagus and gastro-oesophageal junction. These techniques remove lesions involving mucosal and superficial submucosa only.1


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    Multiple specimens may be received in the same or separate containers, including areas adjacent to lesions as separate resections to ensure complete resection.

    All specimens should be submitted pinned to a firm base by the clinician. The specimens may or may not be orientated with markers identifying relevant margins. Pinning will ensure accurate orientation and prevent tissue distortion.

    If received unpinned, orientate and identify mucosa if possible. Pin on to a corkboard (or similar) with mucosa upward and leave to fix sufficiently before dissection.


    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the proximal, distal and lateral margins of the specimen from orientation markers (if present). A clockface orientation may be appropriate with the orientating suture placed at 12 o’clock.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen(s) if required.

    Describe the following features of the specimen (for each piece received):

    Procedure

    Record as stated by the clinician.

    Endoscopic resection

    • Oesophagus
    • Gastro-oesophageal junction
    • Other, specify

    Orientated

    • No
    • Yes, state how orientated

    Number of pieces received

    • Describe

    Specimen integrity

    • Intact
    • Disrupted
      • Mucosal defects present
      • Number
      • Maximum dimension (mm)

    Specimen size (mm)

    • Length x width

    Tumour/lesion

    • No macroscopically visible lesions
    • Lesion present
      • Number
      • If more than one lesion, designate and describe each separately

    Tumour/lesion size (mm)

    • Length x width

    Lesion appearance

    Describe the macroscopic appearance of the lesion (if possible)
    • Nodular
    • Polypoid
    • Ulcer
    • Thickening
    • Scar

    Distance to margins (mm)

    • Distance of lesion to nearest transverse and longitudinal margins
    • Specify margin if orientated

    Dissection

    Paint the deep margin of all specimens with ink, even if not orientated, to ensure entire depth of the resection is examined. Paint the lateral margins with different inks to ensure correct identification of proximal and distal orientation (if orientated by the clinician).

    Dissect the specimen and submit sections for processing according to the diagram provided.

    Section the specimen transversely at 3-4mm intervals; sequentially from proximal to distal ends.


    Internal Inspection

    Not required.


    Processing

    Every mucosal section should be embedded on the same side to ensure equal sampling intervals and spotting the obverse surface (surface upwards at embedding) with ink may be appropriate.

    Submit all sequential sections for processing with no more than four pieces in each cassette.1

    The first (proximal) and last (distal) slices may be inverted to allow the proximal/ distal margins to be sectioned first.

    An illustrated block key similar to the one below may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A
    Proximal section, en-face
     
    B-E
    Sequential transverse sections
     
    F
    Distal section, en-face
     
     

    Acknowledgements

    Prof Priyanthi Kumarasinghe for her contribution in reviewing and editing this protocol.


    References

    1. Kumarasinghe P, Brown I, Charlton A, de Boer B, Eckstein R, Epari K, Gill A, Lam A, Lauwers G, Streutker C, Raftopoulos S, Bourke M and Price T. Endoscopic resection of the oesophagus and gastro-oesophageal junction structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2013.

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      Oes EMR 1

      Oesophageal EMR specimen

      Oes EMR 2

      Oesophageal EMR dissection

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      22-Mar-2019
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