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How to manage EMR/ESD resection specimen for accurate histological assessment
Epublication WebSurg.com, Feb 2016;16(02). URL: http://websurg.com/doi/lt03enlehr003
In this lecture, Dr. Lehr outlines the various methods of handling the resected specimens. The importance of ‘en bloc’ resection over piecemeal resection is highlighted. ESD specimens are usually resected ‘en bloc’, hence 82% of the resections are R0, and the risk of recurrence is less than 1%. As for EMR, 48% of specimens are piecemeal. Consequently, an accurate assessment of the resection margin cannot be achieved and the risk of recurrence is greater than 6%. The true depth of the tumor can only be assessed when the lesion is resected in one piece and with the avoidance of electrocautery injuries inside or at the edges of the lesion. The specimen must be fixed on a Styrofoam or in specialized boxes to prevent it from curling up once put in formalin. Specimen orientation is essential in order to help the pathologist for proper examination and reporting.