Automatic Embedding Technique for Histopathological Examination Increases R0 Resection Rates for Endoscopic Submucosal Dissection: A Major Impact in Decreasing Local Risk Status for Anorectal Cases

Aims Endoscopic submucosal dissection (ESD) allows « en-bloc » resection of superficial gastrointestinal neoplasia. Standardized macroscopic and microscopic approaches are required to adequately assess the curative status. Nevertheless, margin assessment is sometimes challenging especially if samples are not correctly orientated within paraffin blocks.The aim of the study was to compare margin status of ESD specimens embedded using one of two methods: a manual embedding technique (MET) or an automatic embedding technique (AET).

Methods Data from consecutive ESDs performed between June 2015 and November 2020 in a single center (Erasme University Hospital) were collected. For MET, orientation of slices was realized by a technician within the paraffin while for AET, the pathologist orientated slices using a gel (Tissue-Tek Paraform Biopsy Gel-Sakura) and the blocks were embedded using an automate (Tissue-Tek AutoTEC a120-Sakura). Microscopy of all ESD specimens was revised by two pathologists. ESDs were realized for dysplastic lesions or cancer arising from esophagus (32 % MET-30 % AET), stomach (21 % MET- 20 % AET), duodenum (1 % AET), colon (9 % MET-6 % AET) and anorectal location (38 % MET-43 % AET).

Results 189 ESDs were collected: 100 with MET and 89 with AET. We observed positive margins in 29 % and 6.7 % for MET group and AET group, respectively (p=0.00031). In MET group, positive margins were lateral in 23 cases (79.3 %) and deep in 6 cases (20.7 %) while in AET group, positive margins were lateral in 3 cases (50 %) and deep in 3 cases (50 %) (p=NS). AET displayed lower positive margins rate in anorectal lesions (8 %) than MET (37 %) (p=0.005). AET decreased local recurrence risk (0 % compared to 31 % for MET) in anorectal lesions (p<0.001).

Conclusions AET results in improved margin status of ESD specimens, especially with regard to lateral margins in anorectal cases, resulting in decreased local risk status, and potentially more appropriate surveillance interval.

Citation: Verset L, Bucalau A-M, Figueiredo Ferreira M et al. eP240 AUTOMATIC EMBEDDING TECHNIQUE FOR HISTOPATHOLOGICAL EXAMINATION INCREASES R0 RESECTION RATES FOR ENDOSCOPIC SUBMUCOSAL DISSECTION: A MAJOR IMPACT IN DECREASING LOCAL RISK STATUS FOR ANORECTAL CASES. Endoscopy 2021; 53: S176.

Publication History

Article published online:
19 March 2021