Good handling and pathological examination of endoscopic resections of early Barrett's cancer

Handling and pathological examination of endoscopic resections of early Barrett's cancer is very important since it provides the basis for deciding whether subsequent surgical treatment is necessary or not. It is recommended that (i) the resected specimens should be unfolded and pinned to a cork mat; (ii) the margins of resection should be identified by marking with Indian ink, and (iii) the entire specimen must be strip-sectioned and embedded prior to histological evaluation.For the histological evaluation the following information is needed: (i) depth of infiltration, differentiated as m1–m4 and sm1–sm3; (ii) evaluation of the resection margins, lateral and deep (R0/R1); (iii) degree of differentiation (G1–G4) and (iv) invasion of lymphatic or blood vessels.Current information in the literature regarding the risk for regional lymphogenic metastatic spread identify ‘low risk’ as G1/G2, m1–m4 (possibly sm1 absent further risk factors), L0, V0, R0 and ‘high risk’ as G3/G4, sm2, sm3, L1, V1.