Histologische Klassifikation: Beurteilung von Resektaten nach EMR / ESD – Regressionsstadien nach präoperativer Vorbehandlung

Zusammenfassung

Die zunehmende Überwachung von Patienten mit Barrettschleimhaut führt zu einer zuneh­menden Diagnostik früher Karzinomformen mit nur geringer Invasionstiefe. Vergleichbar zu asiatischen Ländern, in denen aufgrund der höheren Inzidenz von Magenkarzinomen eine engmaschige Überwachung von Risikopatienten durchgeführt wird, werden auch zunehmend in europäischen Ländern endoskopische Resektionen von sogenannten Frühkarzinomen des Magens oder frühen Karzinomen des Ösophagus vorgenommen. Neben der Kenntnis der endoskopischen Techniken müssen auch bestimmte Anforderungen an das zu gewinnende Resektat gestellt werden, die eine gute pathohistologische Aufarbeitung ermöglichen. Nur so kann die genaue Tie­feninfiltration ermittelt und die Entfernung im Gesunden korrekt bestimmt werden, was für den weiteren Therapieverlauf und die Prognose entscheidend ist. Fortgeschrittene Karzinome des Ösophagus und des Magens werden multi­modal behandelt, sodass vor der endgültigen Therapie zumeist eine neoadjuvante Radio- und / oder Chemotherapie durchgeführt wird. Dies führt zu bestimmten, pathohistologisch nachweisbaren Veränderungen im Karzinomgewebe, denen mit einem Regressionsgrading Rechnung getragen wird. 

Abstract

The surveillance of patients with Barrett mucosa in the distal oesophagus leads to an increase of patients diagnosed with early cancer of the oesoph­agogastric junction and stomach with only superficial infiltration. Comparable to Asian countries where screening of patients at risk is recommended due to the high incidence of gastric cancer, endoscopic resection of early cancer in the stomach and distal oesophagus is inreasing. In spite of the special endoscopic techniques ­there are several requirements for the resected specimen which ensure its exact pathohistological evaluation. This is necessary to detect the exact depth of infiltration and the resection margins. To provide an exact pathohistological diagnosis is important for further therapeutic im­plications and prognosis. Advanced carcinomas of the oesophagus and stomach need multimodal treatment with radiation and chemotherapy. This has a special impact on the tumour which leads to pathohistological detectable changes as esti­mated in the so-called regression grading. 

Schlüsselwörter

Mukosektomie - Submukosektomie - Frühkarzinom - Regressionsgrading

Key words

mucosectomy - submucosectomy - early cancer - regression grading

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