MAGNIFYING ENDOSCOPY-GUIDED DYE MARKING OF ENDOSCOPIC SUBMUCOSAL DISSECTION SPECIMEN PROVIDES AN ACCURATE METHOD FOR ENDOSCOPIC-TO-PATHOLOGIC EVALUATION OF EARLY GASTRIC CANCER

Aims There are a lack of precise and comprehensive point-to-point methods to verify the EGC diagnosis in delineating the lateral extent, differentiation and invasion depth between endoscopic and histopathological evaluation. To solve this limitation, we established a dye marking approach on ESD resected specimen guided by magnifying narrow band imaging (ME-NBI) or magnifying blue laser imaging (ME-BLI).

Methods A total of 30 EGC specimens resected by ESD from 25 patients between January 1, 2020, and January 30, 2021, were enrolled in this study. After resection, endoscopists performed ME-NBI/BLI on pinned specimens to determine the cancerous margins, microvascular vessels (MV) and microstructure (MS) pattern changes. By comparing with pre-ESD ME-NBI/BLI images, malignant or suspected fields were confirmed and different color TMDs were carefully marked on resected specimen.

Fig. 1

Results There were 69 cancerous fields and 51 precancerous fields of all patients of which 68 (98.55%) and 49(96.08%, 95% CI 88.33% to 99.19%) fields were fully detected by post-ESD ME-NBI/BLI. 97.50% of cancerous or precancerous fields detected by pre-ESD ME-NBI/BLI were identified on resected specimen by post-ESD ME-NBI/BLI. 178 out of 180 fields (98.89%) with characteristic MV and 198 out of 201 fields (98.51%) with MS patterns were detected in resected specimen by post-ESD ME-NBI/BLI.

Conclusions We proposed a new endoscopic and pathological co-diagnosis method which provided objective proofs to confirm the correctness of endoscopic diagnosis. TMDs provides indications for pathologists to detect cancerous histopathological proofs. During this feedback and re-study training way, endoscopists are possible to improve their capability in EGC endoscopic evaluation, accumulate important experiences.

Publication History

Article published online:
14 April 2022