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Ayoub F, Khalaf M, Kuang AG, Keihanian T, Jawaid S, Othman MO. Predictors of residual neoplasia after noncurative (R1) endoscopic submucosal dissection of lesions in the gastrointestinal tract. Eur J Gastroenterol Hepatol 2024; 36:1180-1185. [PMID: 38973521 DOI: 10.1097/meg.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a minimally invasive resection technique that enables the en bloc resection of gastrointestinal lesions. Despite en bloc resection, pathological evaluation of lesions can reveal positive vertical or horizontal margins, which is referred to as R1 resection. Not all R1 lesions referred for surgical resection or endoscopic surveillance show evidence of residual tumor. We aimed to identify the predictors of residual neoplasia in patients with an R1 resection following ESD. PATIENTS AND METHODS All lesions resected via ESD between June 2016 and September 2021 at a tertiary referral center were retrospectively identified. Lesions with an R1 resection and adequate follow-up were eligible for inclusion. Patient, lesion, and procedural characteristics were analyzed to identify predictors of residual neoplasia. RESULTS Of 614 lesions, 163 (28%) had R1 resection. Of these, 56 lesions in 51 patients had complete follow-up and were included. Thirteen patients (25.5%) underwent surgical resection and the remainder underwent endoscopic surveillance. Seven (12.5%) patients had residual disease. All patients with residual disease had esophageal carcinoma. Positive deep and lateral margins, severe submucosal fibrosis, and moderate/poorly differentiated tumors were identified as significant predictors of residual neoplasia. CONCLUSION Most R1 lesions (87.5%) resected by ESD did not have residual disease on follow-up. Those without identified risk factors for residual disease, such as esophageal carcinoma, severe submucosal fibrosis, or both histological margin positivity, may benefit from a strategy of close endoscopic surveillance rather than referral for surgical resection.
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Affiliation(s)
- Fares Ayoub
- Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine
| | - Mai Khalaf
- Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine
| | - Andrew G Kuang
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tara Keihanian
- Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine
| | - Salmaan Jawaid
- Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine
| | - Mohamed O Othman
- Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine
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Chow CWS, Fung TLD, Chan PT, Kwok KH. Endoscopic submucosal dissection for colorectal polyps: outcome determining factors. Surg Endosc 2023; 37:1293-1302. [PMID: 36192659 PMCID: PMC9529320 DOI: 10.1007/s00464-022-09672-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has gained increasing popularity in the management of complicated colorectal polyps. However, clinical outcomes for ESD have remained highly inconsistent worldwide. This study investigated and analysed factors that significantly affect ESD outcomes. METHODS We conducted a single-centred retrospective study on 220 colorectal polyps removed by ESD from 1st January 2016 to 31st December 2020. Data were collected and retrieved from clinical records. Variables studied included patient demographics, ESD technicalities and polyp characteristics. The primary outcome was completeness of resection based on en bloc and R0 resection rates. The secondary outcomes were recurrence, complications and hospital stay. Further analysis was performed for significant outcome determining factors. RESULTS The en bloc resection and R0 resection rates were 97.3% and 65% respectively. Intraprocedural and delayed perforation rates were 3.2% and 0.5% respectively. Intraprocedural and delayed bleeding rates were both 1.8%. Post-polypectomy syndrome rate was 2.7%. The median hospital stay was 4 days. Submucosal fibrosis was a significant determining factor for lower en bloc resection (p = 0.004), lower R0 resection (p = 0.002), intraprocedural perforation (p = 0.001), intraprocedural bleeding (p = 0.025) and post-polypectomy syndrome (p = 0.039). Hybrid snaring was associated with lower en bloc resection (p < 0.001), while longer ESD time was associated with lower R0 resection (p = 0.003) and post-polypectomy syndrome (p = 0.025). Other significant factors for post-polypectomy syndrome included young age (p = 0.021) and large polyp size (p = 0.018). Secondary analysis showed that submucosal fibrosis was significantly associated with non-granular lesions (p < 0.001) and prior biopsy (p = 0.003). CONCLUSION Submucosal fibrosis, hybrid snaring, ESD time, age and polyp size were significant outcome determining factors for ESD. By identifying these factors, strategies may be formulated to improve ESD outcomes.
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Affiliation(s)
- Chi Woo Samuel Chow
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
| | - Tak Lit Derek Fung
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Pak Tat Chan
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Kam Hung Kwok
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
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Stier MW, Chapman CG, Shamah S, Donboli K, Yassan L, Waxman I, Siddiqui UD. Endoscopic resection is more effective than biopsy or EUS to detect residual rectal neuroendocrine tumor. Endosc Int Open 2021; 9:E4-E8. [PMID: 33403229 PMCID: PMC7775810 DOI: 10.1055/a-1300-1017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Rectal neuroendocrine tumors (NETs) are often discovered incidentally and may be misidentified as adenomatous polyps. This can result in a partial resection at the index procedure, and lesions are often referred for staging or evaluation for residual disease at the resection site. The aim of this study was to identify the ideal method to confirm complete excision of small rectal NETs. Patients and methods Data from patients with a previously resected rectal NET referred for follow-up endoscopy or endoscopic ultrasound (EUS) were retrospectively reviewed. Univariate analysis was performed on categorical data using the Chi-squared test. Results Forty-nine patients with rectal NETs were identified by pathology specimens. Of those, 39 underwent follow-up endoscopy or EUS and were included. Baseline characteristics included gender (71 % F, 29 % M), age (57.2 ± 13.4 yrs) lesion size (7.3 ± 4.2 mm) and location. The prior resection site was identified in 37/39 patients who underwent tissue sampling. Residual NET was found histologically in 14/37 lesions. All residual disease was found during salvage endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and 43 % had a normal-appearing scar. Every patient undergoing EUS had an unremarkable exam. Initial cold biopsy polypectomy ( P = 0.006), visible lesions ( P = 0.001) and EMR/ESD of the prior resection site ( P = 0.01) correlated with residual NET. Conclusions Localized rectal NETs may be incompletely removed with standard polypectomy. If an advanced resection is not performed initially, repeat endoscopy with salvage EMR or ESD of the scar should be considered. For small rectal NETs, biopsy may miss residual disease when there is no visible lesion and EUS appears to have no benefit.
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Affiliation(s)
- Matthew W. Stier
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
| | - Christopher G. Chapman
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
| | - Steven Shamah
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
| | - Kianoush Donboli
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
| | - Lindsay Yassan
- Department of Pathology, the University of Chicago Medicine, Chicago, Illinois, United States
| | - Irving Waxman
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
| | - Uzma D. Siddiqui
- University of Chicago Center for Endoscopic Research and Therapeutics (CERT), Chicago, Illinois, United States
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Park J, Kim HG, Jeong SO, Jo HG, Song HY, Kim J, Ryu S, Cho Y, Youn HJ, Jeon SR, Kim JO, Ko BM, Jeen YM, Jin SY. Clinical outcomes of positive resection margin after endoscopic mucosal resection of early colon cancers. Intest Res 2019; 17:516-526. [PMID: 31129949 PMCID: PMC6821942 DOI: 10.5217/ir.2018.00169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIMS When determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status. METHODS We examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years. RESULTS According to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist's opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09-91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28-56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76-106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21-17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18-22.34). CONCLUSIONS Subsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.
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Affiliation(s)
- Junseok Park
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Shin Ok Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hoon Gil Jo
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyo Yeop Song
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeeyeon Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seri Ryu
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Youngyun Cho
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Jin Youn
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon Mi Jeen
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea
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Panteris V, Vezakis A, Triantafillidis JK. Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps? World J Gastroenterol 2018; 24:1579-1582. [PMID: 29662295 PMCID: PMC5897861 DOI: 10.3748/wjg.v24.i14.1579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 02/06/2023] Open
Abstract
Standardized approach to polypectomy of diminutive colorectal polyps (DCPs) is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety. This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides well-intentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but non-negligible risk of advanced neoplasia and even cancer. Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps, their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention. Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted.
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Affiliation(s)
- Vasileios Panteris
- Department of Gastroenterology, Sismanogleio-A.Fleming General Hospital, Attiki, Athens 15126, Greece
| | - Antonios Vezakis
- Department of Surgery, Aretaieio Hospital, Attiki, Athens 11528, Greece
| | - JK Triantafillidis
- Department of Gastroenterology, Iaso General Hospital, Attiki, Athens 15562, Greece
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34BetaE12 and Alfa-Methylacyl Coenzyme A Racemase (AMACR) Antibodies Better Than p63 Antibody Distinguish Normal and Neoplastic Glands in Prostatic Tissue With Thermal Artifacts. Appl Immunohistochem Mol Morphol 2018; 27:306-310. [PMID: 29346181 DOI: 10.1097/pai.0000000000000599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The occurrence of inked margins with crush artifact derived from the electrocauterization in radical prostatectomy and/or the presence of crushed areas with distorted glands in prostatic samples after transurethral resection of prostate (TURP) can induce a significant interobserver variability during histopathologic evaluation of specimens. The specific immunostaining for basal cell markers 34BetaE12 and p63 and for alfa-methylacyl coenzyme A racemase (AMACR) in neoplastic cells is commonly used as an ancillary tool to establish benign and malignant glands. In this study we carried out the immunohistochemical reactions for p63, 34BetaE12, and AMACR on 3 different and successive paraffin sections to discriminate malignant and benign prostatic glands, distorted and crushed by the thermal artifacts in 60 radical prostatectomies and 50 TURP samples. All prostatic acinar adenocarcinoma showed the loss of basal cell markers and expression of AMACR, whereas p63 failed to stain the basal cell layer in benign crushed prostatic glands. The same cauterized glands were steadily positive for 34BetaE12. The high percentage of p63 false negative cases in benign distorted and crushed glands could be explained by the thermal artifacts which might cause lack of p63 antigenicity. In contrast, the antigenicity of 34BetaE12 and AMACR seem not to be affected by cautery artifacts. Thus, in cauterized suspicious prostatic glands an immunohistochemistry panel including, p63, 34BetaE12, and AMACR or only 34BetaE12 is recommended. In addition, after the first evaluation with only p63, we suggest that a separate and confirmatory staining for 34BetaE12 is strongly recommended.
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Abstract
Colonic polypectomy is an effective way of reducing colon cancer mortality. Multiple techniques now exist for the resection of polyps, and the endoscopist must decide on the appropriate resection approach for individual patients and lesions. This decision should maximize efficacy, safety and cost-effectiveness and provide optimal oncological outcomes while minimizing unnecessary surgical treatment. Advances in endoscopic imaging technology are improving the accuracy of endoscopic diagnosis and allowing more precise risk assessment of colonic lesions. Resection technique can be tailored to the endoscopic findings. Diminutive (≤5 mm) and small polyps (≤9 mm) are best resected primarily by snare techniques. Cold snare polypectomy has proven safety, but efficacy and technique require further study. There is variation in techniques used for polyps 6-20 mm in size and incomplete resection rates for conventional polypectomy may be considerable. Endoscopic mucosal resection (EMR) is well established, safe and effective for lesions without submucosal invasion (SMI); however, recurrence is a key limitation. Endoscopic submucosal dissection (ESD) is well established in the East; however, it is resource intensive and its role in lesions with a low risk of SMI is questionable. ESD in the West remains incompletely defined and is associated with high adverse event rates, but it is becoming increasingly available and successful as experience grows. Emerging full-thickness resection technologies are still in their infancy and remain experimental as a result of the absence of reliable closure devices and techniques. Patient-focused outcomes should guide technique selection.
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Affiliation(s)
- Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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8
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Saini AK, Ahuja A, Seth A, Dogra PN, Kumar R, Singh P, Gupta SD. Histomorphological features of resected bladder tumors: Do energy source makes any difference. Urol Ann 2015; 7:466-9. [PMID: 26692666 PMCID: PMC4660697 DOI: 10.4103/0974-7796.157970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Context: The recent advent of bipolar energy in bladder tumor resection has raised many questions regarding density of current and its effect on histopathology of the resected transurethral resection of bladder tumor (TURBT) chips. Aims: The aim of this study is to evaluate the histomorphological features in resected bladder tumors comparing bipolar versus conventional (monopolar) energy. Settings and Design: Inclusion criteria were patients with primary presentation of carcinoma urinary bladder undergoing TURBT. The patients with prior resections were excluded as these could jeopardize the results of cautery artifacts. Materials and Methods: From February 2010 to December 2011, 61 patients with primary carcinoma bladder and meeting our inclusion criteria were compared. Group 1 (n = 31) underwent bipolar-TURBT (B-TURBT) and Group 2 (n = 30) monopolar-TURBT (M-TURBT). Two pathologists, who were blinded to the form of electrocautery used, examined the resected tissue. The degree of cautery artifact in each specimen was recorded. The severity of the cautery artifact was graded as absent, mild, moderate, or severe. The mean age, tumor size, and resection time were recorded in both groups. Statistical Analysis Used: Data were analyzed using SPSS 16. Data were compared in between groups using paired t-test and Pearson's Chi-square test. The significance level was set at 0.05. Results: The mean age, tumor size, and resection time were similar in between the two groups. The pathologists had no obscurity in reaching a correct diagnosis in all cases. The cautery artifacts were graded as absent in 10 (32.2%) and 8 (26.67%), mild in 12 (38.7%) and 11 (36.67%), moderate in 5 (16.1%) and 7 (23.33%) and severe in 4 (12.9%) and 5 (16.66%) cases, respectively in Group 1 and 2. There was no statistically significant histomorphogical dissimilarity between specimens according to the type of cautery used. Conclusions: Bladder tissue obtained from B-TURBT is of equivalent histomorphological feature as that of standard M-TURBT.
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Affiliation(s)
- Ashish Kumar Saini
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Prem Nath Dogra
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All Institute of Medical Sciences, New Delhi, India
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McCroskey Z, Wojcik EM. Electrothermal cautery artifact in a urine cytology specimen. Diagn Cytopathol 2015; 43:833-4. [PMID: 25914104 DOI: 10.1002/dc.23283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Zulfia McCroskey
- Department of Pathology, Loyola University Medical Center, Chicago, Illinois
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, Chicago, Illinois
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10
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Burgess NG, Bahin FF, Bourke MJ. Colonic polypectomy (with videos). Gastrointest Endosc 2015; 81:813-35. [PMID: 25805461 DOI: 10.1016/j.gie.2014.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Farzan F Bahin
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Yasar B, Kayadibi H, Abut E, Benek D, Kochan K, Gonen C. The histological quality and adequacy of diminutive colorectal polyps resected using jumbo versus hot biopsy forceps. Dig Dis Sci 2015; 60:217-225. [PMID: 25112723 DOI: 10.1007/s10620-014-3320-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polypectomy with jumbo forceps (JF) and polypectomy with hot biopsy forceps (HBF) are still widely used techniques for removal of diminutive colorectal polyps (DCPs). JF may be more effective for the removal of DCPs because of their larger size. AIM To evaluate the histological quality and adequacy of DCPs resected using JF compared with HBF. METHODS One hundred and seventy-nine patients with 237 DCPs were included in this study. DCPs were removed using either JP or HBF. RESULTS The tissue architecture was good in 29.9 % of the HBF group, in comparison with 90 % of the JF group (p < 0.001). No cautery damage or crash artifact was observed in 93.3 % of JF group and in 8.5 % of HBF group (p < 0.001). Moreover, there were statistically significant differences between the groups with regard to the high level of cautery damage or crush artifact (p < 0.001). The overall diagnostic quality of the specimens removed using JF was significantly better than that of the specimens removed by HBF (96 vs. 80 %, respectively, p < 0.001). There were statistically significant inverse associations between cautery damage or crush artifact and overall diagnostic quality of HBF and JF (r = -0.373, p < 0.001; r = -0.382, p < 0.001, respectively). Surgical margins were determined as negative in 87.5 % of the JF group and in 76.1 % of the HBF group (p = 0.022). A total of 80.8 % of the JF specimens and 30.8 % of the HBF specimens were well evaluated for two lateral and deep surgical margins (p < 0.001). CONCLUSION JF was superior to HBF for histopathological interpretation and eradication of DCPs.
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Affiliation(s)
- Bulent Yasar
- Department of Gastroenterohepatology, Camlica Erdem Hospital, Alemdag Yanyol Street, 34696, Üsküdar, Istanbul, Turkey,
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12
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Matsukuma S, Takeo H, Sato K. Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study. Mol Clin Oncol 2014; 2:882-886. [PMID: 25054062 DOI: 10.3892/mco.2014.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/29/2014] [Indexed: 11/05/2022] Open
Abstract
To delineate the characteristics of nuclear artifacts associated with endoscopic submucosal dissection (ESD), we examined 97 gastric ESD specimens from 79 patients. In 69 of the specimens (71%), multinucleated figures and/or atypical mitotic-like figures, including tripolar-like and bizarre spindles, were found in the peripheral portions close to the marking areas. These nuclear figures were mostly recognizable as artifacts, but were infrequently (13 specimens) accompanied by other nuclear alterations and/or architectural abnormalities, mimicking dysplasia. However, in the deep cut sections, the dysplastic characteristics tended to disappear and coagulative or degenerative findings became more prominent. These nuclear artifacts were not found in 69 age- and gender-matched control gastrectomy specimens without ESD. Multinucleated artifacts were associated with the size of the ESD specimens (P=0.003), frequency of marking (P<0.001) and a history of 'previous' marking 1-6 days prior to ESD (P<0.001); however, they were not associated with age, ESD procedure time, or 'fresh' marking on the day of the ESD. Atypical mitosis-like characteristics were associated with a history of 'fresh' (P=0.007) as well as 'previous' (P=0.002) marking, but not with other variables. Dysplasia-like artifacts were associated with older age only (P=0.031). Follow-up data of all the patients with nuclear artifacts showed no aggressive behavior. Therefore, we concluded that these nuclear changes were ESD-related artifacts. Particularly in older patients, these changes may simulate dysplasia and must be distinguished from true dysplasia or neoplasia.
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Affiliation(s)
- Susumu Matsukuma
- Health Care Center, Japan Self-Defense Forces Central Hospital, Tokyo 154-0001, Japan ; Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo 154-0001, Japan
| | - Hiroaki Takeo
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo 154-0001, Japan
| | - Kimiya Sato
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo 154-0001, Japan
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Tutticci N, Bourke MJ. Advances in colonoscopy. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2014; 12:119-139. [PMID: 24615389 DOI: 10.1007/s11938-014-0009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Colonoscopy with polypectomy has been established as the major prevention and detection strategy for colorectal cancer for over a decade. Over this period advances in colonoscopic imaging, polyp detection, prediction of histopathology and polypectomy techniques have all been seen; however, the true magnitude of the limitations of colonoscopy has only recently been widely recognized. The rate and location of missed or interval cancers after complete colonoscopy appears to be influenced by the operator-dependency of colonoscopy and failure of conventional practices to detect and treat adenomatous, and possibly more importantly, non-adenomatous colorectal cancer precursors. Consequently, studies that expand our understanding of these factors and advances that aim to improve colonoscopy, polypectomy, and cancer protection are of critical importance.
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Affiliation(s)
- Nicholas Tutticci
- Department of Gastroenterology and Hepatology, Westmead Hospital, 106A/151 Hawkesbury Road, Westmead, NSW, 2145, Australia,
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Palermo SM, Dechet C, Trenti E, Mian C, Lodde M, Comploj E, Mazzoleni G, Hanspeter E, Ambrosini Spaltro A, Mayr R, Pycha A. Cytology as an Alternative to Frozen Section at the Time of Nephron-sparing Surgery to Evaluate Surgical Margin Status. Urology 2013; 82:1071-5. [DOI: 10.1016/j.urology.2013.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/04/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Metz AJ, Moss A, McLeod D, Tran K, Godfrey C, Chandra A, Bourke MJ. A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model. Gastrointest Endosc 2013. [PMID: 23199650 DOI: 10.1016/j.gie.2012.09.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although linked with perforation, serositis, delayed bleeding, and incomplete resection, hot biopsy forceps electrocauterization (HBF) is still widely used for diminutive colonic polypectomy. OBJECTIVE To evaluate the safety and efficacy of HBF in comparison with conventional snare polypectomy (CSP). DESIGN Randomized, blinded, controlled trial. SETTING Academic endoscopy unit. SUBJECTS Ten swine. INTERVENTION Eighty-two paired polypectomies (41 HBF, 41 CSP) of small, minimally elevated, artificial lesions. Standardized technique using coagulating current at 25 W. HBF: the tissue was avulsed after 1 to 2 seconds of current caused blanching of the artificial pedicle. CSP: the polyp was removed by snare diathermy. MAIN OUTCOME MEASUREMENTS Histopathology of resected specimens and polypectomy sites in colectomy specimens at necropsy (lateral mucosal and depth of ulceration, necrosis and inflammation). RESULTS Some (21%) of the HBF specimens were ablated and uninterpretable. All CSP specimens yielded interpretable specimens. Mucosal necrosis adjacent to HBF resection sites varied widely, between 1.5 and 9 mm (mean 5.7 mm, standard deviation ± 2). There was visible mucosa under the HBF ulcer in 14% of cases. The depth of necrosis in the colon wall was significantly different between the two techniques, with partial muscularis propria (MP) necrosis in 14 of 41 lesions (34%) with HBF, compared with 1 of 41 (2%) of CSP (P < .001), and full-thickness MP necrosis in 9 of 41 lesions (22%) with HBF, compared with 1 of 41 (2%) of CSP (P = .014). There was full-thickness MP inflammation in 13 of 41 lesions (32%) with HBF compared with 5 of 41 (12%) of CSP (P = .06). Transmural subserosal inflammation was seen in 13 of 41 lesions (32%) with HBF compared with 4 of 41 (10%) of CSP (P = .027). There was no relationship between visible lateral mucosal injury and depth of injury (rs = -0.07). LIMITATIONS Animal study. CONCLUSION Despite use of the standardized HBF technique, there is a wide range of lateral mucosal and deep thermal injury as well as residual target mucosa. HBF also results in a significantly greater depth of tissue injury, with a high proportion of transmural necrosis. Ensuring minimal blanching of the mucosa during the procedure does not protect from deep injury. In comparison to conventional snare polypectomy, HBF is imprecise, potentially ineffective, and hazardous.
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Affiliation(s)
- Andrew J Metz
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
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Abstract
Modern evaluation of specimens from biopsies of colorectal polyps has become increasingly complex because of tremendous progress in the understanding of colorectal neoplasia. Although pathologists are generally familiar with the basic handling of carcinoma in the setting of polypectomies or resections, the comprehensive evaluation of specimens from biopsies of colorectal polyps obtained with forceps is far from intuitive and has yet to be reviewed. Comprehensive evaluation requires always addressing several key issues, even when dealing with seemingly routine cases. These issues include taking further action when initial sections lack polyps, accurately quantitating polyps, accurately classifying polyps, determining whether thresholds are met for considering conditions at high risk for carcinoma, detecting incidental findings other than polyps, and determining which incidental findings are clinically significant. In particular, polyposis with attenuated phenotype or Lynch syndrome may be clinically occult, and the possibility of these entities should always be kept in mind, regardless of age or history. Ancillary studies performed immediately on carcinoma that is detected at biopsy guides surgery, guides medical therapy, prognosticates, provides evidence for hereditary neoplasia, and guides surveillant colonoscopy for the family.
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Warnecke M, Engel UH, Bernstein I, Mogensen AM, Holck S. Biopsies of colorectal clinical polyps – emergence of diagnostic information on deeper levels. Pathol Res Pract 2009; 205:231-40. [DOI: 10.1016/j.prp.2008.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 07/27/2008] [Accepted: 08/05/2008] [Indexed: 02/08/2023]
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Groisman GM, Amar M, Meir A. Utility of MIB-1 (Ki-67) in Evaluating Diminutive Colorectal Polyps With Cautery Artifact. Arch Pathol Lab Med 2007; 131:1089-93. [PMID: 17616996 DOI: 10.5858/2007-131-1089-uomkie] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Accurate interpretation of colorectal polyp histology is essential in the decision-making process during treatment and surveillance following polypectomies. However, interpretation of diminutive colorectal polyps removed by thermal electrocoagulation (hot biopsy technique) is often problematic as a result of cautery artifact.
Objective.—To evaluated the usefulness of the proliferation marker MIB-1 (Ki-67) as an aid in the differential diagnosis of diminutive colorectal polyps with cautery artifact, as adenomatous and nonadenomatous polyps display different patterns of epithelial proliferation.
Design.—Seventy-five diminutive colorectal polyps with extensive cautery artifact displaying at least the upper portions of 3 adjacent crypts with the corresponding surface epithelium were evaluated and immunolabeled with MIB-1. They included 25 cases in which a definitive or presumptive diagnosis could not be reached (indeterminate polyps), 25 cases diagnosed as compatible with adenomatous polyp, and 25 cases diagnosed as compatible with nonadenomatous polyp.
Results.—MIB-1 immunoreactivity was well preserved in the cauterized areas. Among indeterminate polyps, MIB-1 stained upper crypts and surface epithelium in 14 cases (adenomatous polyp staining pattern) and revealed minimal or absent staining in these areas in 11 cases (nonadenomatous polyp staining pattern). All cases diagnosed as compatible with adenomatous polyp displayed the adenomatous polyp staining pattern. In contrast, all cases diagnosed as compatible with nonadenomatous polyp revealed the nonadenomatous polyp staining pattern.
Conclusions.—Immunoreactivity for MIB-1 may be used as a beneficial adjunctive test to help diagnose diminutive colorectal polyps with extensive cautery artifact.
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Affiliation(s)
- Gabriel M Groisman
- Department of Pathology, Hillel Yaffe Medical Center, Hadera 38100, Israel.
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