Korean J Gastroenterol.  2010 Nov;56(5):293-298. 10.4166/kjg.2010.56.5.293.

Comparison of the Cut Direction between Gross Finding, Streoscopic Finding, and Pathologic Mapping of Endoscopic Submucosal Dissection Specimen

• Cho YK
• Cho JY
• Jin SY
• Cho WY
• Jung YH
• Lee TH
• Kim HG
• Kim JO
• Lee JS

• KMID: 1718370
• DOI: http://doi.org/10.4166/kjg.2010.56.5.293

Abstract

BACKGROUND/AIMS
The correct pathologic review is very important after endoscopic submucosal dissection. The cut direction of specimen should be the right angle of the closest area between the lesion and the lateral margin for the correct pathologic review. The aim of this study was to evaluate the concordance of the gross finding and stereoscopic finding compared to the pathologic mapping in the setting of the cut direction.
METHODS
Between December 2008 and May 2009, the objects were 48 specimens in 46 patients who were diagnosed with early gastric cancer and high grade adenoma after endoscopic submucosal dissection. The specimens were stained with hematoxylin and observed by the stereoscopy and analyzed by the image analysis system. The cut direction was divided by an angle of 45 degree based on the oral side of the specimen, and the cut directions of the gross finding, the stereoscopic finding, and the pathologic finding were compared.
RESULTS
The concordance of the gross finding in the setting of the cut direction was 68% (33/48), and the kappa value was 0.626, and the concordance of the stereoscopic finding in the setting of the cut direction was 87% (33/48), and the kappa value was 0.874. The accuracy of the gross finding was significantly lower than that of the stereoscopic finding in the setting of the cut direction (p<0.05).
CONCLUSIONS
The endoscopist needs the careful observation and close attention in the setting of the cut direction of the specimen by gross finding, and stereoscopic analysis may be a useful tool for decision of the cut direction.

Keyword

Endoscopic submucosal dissection; Stereoscopy; Cut direction

MeSH Terms

Adenoma/pathology/surgery
Dissection/*methods
Female
Gastric Mucosa/*pathology/surgery
Gastroscopy/*methods
Humans
Male
Middle Aged
Stomach Neoplasms/pathology/surgery

Figure

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  Fig. 1. Cut direction. (A) Correct direction. (B) Wrong direction.

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  Fig. 2. (A) Stereoscopy. (B) Image analysis software.

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  Fig. 3. Method of the analysis. (A) Analysis of the specimen. ① Setting of the lateral margin. ② Setting of area of the lesion. ③ Setting of the cut direction. (B) The cut direction is divided an angle of 45 degree based on the oral side of the specimen.

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  Fig. 4. (A) Gross finding. (B) Stereoscopic finding. (C) Pathologic mapping.

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  Fig. 5. The correlation between stereoscopic finding and pathologic finding. (A) Lateral margin. (B) Area.

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