IMP POINTS IN REPORTING ESOPHAGEAL CANCER.pptx

How to report biopsy of an esophageal cancer

1. BIOPSY REPORTING OF ESOPHAGEAL CANCER

2. Introduction The proposal for reporting of oesophageal cancer should be implemented for following reasons. Prognostic information for patients. Prognostic information for clinicians. Feed back to surgeon on quality of resection and effect of neoadjuvant therapy . Feed back for other specialities e.g radiology.

3. Usefulness of Guidelines TNM Staging of esophageal carcinoma. Handling of esophageal specimen. Includes the data required for adequate reporting of esophageal specimens containing cancer.

4. SPECIMEN RECIEPT AND PREPARATION Esophagectomy specimen contract immediately and lose a quarter of their natural length if fixed without being pinned. When the specimen is measured, note should be made of whether or not the specimen was pinned.

5. TISSUE SAMPLING The following blocks of tissue are recommended as a minimum sampling; proximal resection margin distal resection margin Three blocks of tumour to show closest approximation of tumour to circumferential margin and relationship to adjacent mucosa. Sampling of lymph node

6. CORE DATA Maximum tumour diameter Siewert tumour type ( cardiac tumours only ) Maximum depth of invasion ( anatomical layer ) Polypoidal or other morphology Histological type Grade of malignancy

7. CORE DATA ( Continued ) Serosal involvement Resection margins ( proximal, distal resection margin ) Vascular invasion Lymph node status

8. NON-CORE DATA Comment on specimen preparation Overall dimensions of specimen Presence of Barrets metaplasia Effect of neoadjuvant therapy ( if applicable ) Molecular data (if applicable )

9. GROSS DESCRIPTION Overall dimension of the specimen Length of esophagus and stomach Maximum length of tumour Tumour size and distance to resection margins.

10. MICROSCOPIC FEATURES Histological type of tumour Adenocarcinoma Squamous carcinoma Adenosquamous Small cell carcinoma 2.Tumour differentiation 3. Dysplasia 4. Depth of invasion

11. MICROSCOPIC FEATURES (CONTINUED) 5.Proximal and distal margins 6.Circumferential resection margin (CRM or R) R0 resection – fully resected tumour with no involvement of any margins R1 resection – Macroscopically a clear resection but which proves on histologial examination to have positive margins. R2 resection – in which margin involvement is obvious

12. MICROSCOPIC FEATURES (CONTINUED) 7.Vascular invasion 8.Perineural invasion 9.Lymph node stage and numbers of involved nodes 10.Barret metaplasia 11.Other markers like ploidy,angiogenesis,CD44, and EGFR.

13. DATASET FOR AN INITIAL BIOPSY DIAGNOSIS OF OESOPHAGEAL CARCINOMA Identify the type of carcinoma Presence of overlying squamous cell dysplasia,glandular dysplasia or barret dysplasia Submucosal invasion is important prognostic factor of nodal metastasis.