Endoscopy 2019; 51(04): S167-S168
DOI: 10.1055/s-0039-1681665
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 10:30 – 11:00: Barrett therapy ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

OPTIMIZING HISTOPATHOLOGICAL EVALUATION OF ENDOSCOPIC MUCOSAL RESECTION SPECIMENS OF BARRETT'S ESOPHAGUS RELATED NEOPLASIA: A RANDOMIZED TRIAL OF THREE SPECIMEN HANDLING METHODS

A Overwater
1   Dept. of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
2   Dept. of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
,
KE van der Meulen
1   Dept. of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
HT Künzli
1   Dept. of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
EJ Schoon
3   Dept. of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands
,
JJGHM Bergman
4   Dept. of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
,
GM Raicu
5   Pathology DNA, St. Antonius Hospital, Nieuwegein, Netherlands
,
CA Seldenrijk
5   Pathology DNA, St. Antonius Hospital, Nieuwegein, Netherlands
,
BLAM Weusten
1   Dept. of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
2   Dept. of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic resection (ER) is the cornerstone in the treatment of Barrett's esophagus (BE) related neoplasia. However, accurate histopathological evaluation of ER specimens can be challenging and the preferred specimen handling method remains unknown. Therefore the aim of our study was to compare three different specimen handling methods for the assessment of all clinically relevant histopathological parameters and for the time required for specimen handling.

Methods:

In this multicenter, randomized trial, endoscopic mucosal resection (EMR) specimens of BE related neoplasia with no suspicion of submucosal invasion during endoscopy were randomized to three specimen handling methods: pinning on paraffin, direct fixation in formalin, and the cassette technique. The histopathological evaluation scores were assessed by two dedicated gastrointestinal pathologists blinded for the handling method.

Results:

Of the 126 randomized EMR specimens, 45 were assigned to pinning on paraffin, 41 to direct fixation in formalin, and 40 to the cassette technique. The percentages of specimens with overall optimal histopathological evaluation scores were similar for the pinning method (98%) and for no handling (90%), but significantly lower for the cassette technique (64%, p < 0.001). Time required for specimen handling was shortest when no handling method was used (p < 0.001 vs. pinning and cassette).

Conclusions:

Both pinning on paraffin and direct fixation in formalin result in optimal histopathological evaluation scores in a high proportion of specimens, while the cassette technique performs significantly worse and its use in clinical daily practice should be discouraged. Given the significantly shorter handling time, direct fixation in formalin appears to be the preferred method over pinning on paraffin. However, the latter needs to be confirmed in larger studies with inclusion of all EMR specimens.