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The importance of the role of the histopathologist in the management of patients with oesophageal disease cannot be overemphasised. Pathological examination of specimens from these patients provides:
Essential diagnostic and prognostic information for optimal clinical management.
Material for research and audit.
A database for epidemiological studies.
A close liaison between the surgeon, gastroenterologist, and histopathologist is of paramount importance, particularly in the evaluation of dysplasia or early carcinoma in Barrett's oesophagus and, generally, to maximise diagnostic yield in any situation. The extent and usefulness of pathological information that can be conveyed to the clinicians is determined by the adequacy of clinical information, biopsy sampling, handling, laboratory processing, and any special studies that may be required. It is also influenced by the awareness of the histopathologist of the normal anatomy and histology of the oesophagus. There should be regular meetings between the surgeon, gastroenterologist, and histopathologist to discuss clinical and pathological findings.
Collection and preservation of specimens
The endoscopist should ensure that a separate container is used for biopsies taken from different sites so that the precise location of each biopsy can be identified. Containers should be properly labelled, including the number and site of the biopsy (for example, biopsy No 2 at 33 cm). Interpretation of the biopsy is considerably enhanced if it is taken with a large forceps and oriented1 (with its mucosal surface, if it is identifiable, upwards on small squares of porous non-soluble paper tissue) and placed immediately in an appropriate fixative (usually buffered 10% formalin or 10% formol saline). Biopsies should then be processed, embedded, and cut correctly oriented, having their luminal surface on one side of the section and the submucosal surface on the other. This is particularly important for the assessment of epithelial dysplasia or stromal invasion. However, small fibreoptic biopsies and those for malignant disease usually do …