Purpose The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5–7 mm) than those for endoscopically resected specimens (2–3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD). Materials and Methods This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI. Results Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7–80.3% (P<0.001 for all three sets) and 55.3–63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4–10 (2.7%–6.7%) at 4-mm intervals, and 10–17 (6.7%–11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI. Conclusions After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up.

中文翻译：

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基于病理切片间隔评估早期胃癌黏膜下或淋巴管侵犯检出率


目的早期胃癌（EGC）病理评估指南建议手术标本的切片间隔（5-7毫米）比内镜切除标本（2-3毫米）更宽。对手术切除的 EGC 标本的研究表明，符合内镜粘膜下剥离术 (ESD) 扩展标准的 EGC 存在不可忽视的淋巴结转移风险。材料和方法 这项回顾性研究包括 386 名患者中检测到的 401 个 EGC 病变，内镜下大小≤ 30 mm。将ESD或手术获得的病理标本切成2mm间隔以供参考。以 4 或 6 毫米切片间隔任意评估粘膜下或淋巴血管侵犯 (LVI)。 McNemar 的测试比较了粘膜下层和 LVI 之间的差异。结果 2 mm 间隔内，29.2% (117/401) 检测到粘膜下浸润，9.5% (38/401) 检测到 LVI。 4 mm间隔粘膜下侵犯检出率下降至88.0%或90.6%（均P<0.001），而LVI检出率下降至86.8%或57.9%（分别P=0.025和P<0.001）。在 6 毫米间隔内，粘膜下和 LVI 检出率分别进一步下降至 72.7-80.3%（所有三组 P<0.001）和 55.3-63.2%（所有三组 P<0.001）。在 150 例间隔 2 毫米的适应证外病例中，间隔 4 毫米的 4-10 例（2.7%-6.7%）和间隔 6 毫米的 10-17 例（6.7%-11.3%）被错误分类为病变由于低估了粘膜下层或 LVI，满足根治性切除标准。结论 ESD术后2mm宽的切片间隔适合局灶性粘膜下或LVI的病理学评估。因此，如果 EGC 病变符合 ESD 标本病理评估的扩展标准，则可以安全地进行随访。