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Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens
  1. Zixiang Yu1,
  2. Dongxian Jiang1,
  3. Wen Huang1,
  4. Rongkui Luo1,
  5. Haixing Wang1,
  6. Jieakesu Su1,
  7. Jia Liu1,
  8. Chen Xu1,
  9. Yingyong Hou1,2,3
  1. 1 Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
  2. 2 Department of Pathology, School of Basic Medical Sciences & Zhongshan Hospital, Fudan University, Shanghai, China
  3. 3 Department of Pathology, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, Fujian, China
  1. Correspondence to Professor Yingyong Hou, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China; houyingyong{at}; Dr Chen Xu, Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China; xu.chen{at}


Aims Accurate histopathological evaluation of the endoscopic submucosal dissection (ESD) specimens is essential for clinicians to guide further triage and management. This study aimed to report a novel processing technique for large ESD (≥4 cm) specimens.

Methods 92 patients with colorectal neoplasms who had undergone ESD were included. 46 ESD specimens were treated with conventional handling process, while the rest 46 cases were given the optimised method. Macrobiocassettes and L-shaped embedding moulds were applied in the optimised method. We evaluated the efficacy of this improved procedure in terms of the number of paraffin blocks, storage space and time consumption of pathological assessment.

Results The average diameter of ESD specimens was 4.5±0.4 cm and 4.7±0.5 cm in the control and test group (p=0.023), respectively. In control group, 398 paraffin blocks of 46 cases were obtained. With the same cases number and larger lesion size, only 276 blocks were achieved in test group (p<0.001). As for the storage space, the total volume of paraffin blocks and slides (4554.0 cm3 and 1207.5 cm3) of optimised method was significantly reduced compared with the control group (6208.8 cm3 and 1741.3 cm3) (p=0.001, p<0.001). In addition, the optimised method was superior to the conventional one in shortening time consumption of pathological assessment (164.5 min and 269.0 min, p<0.001).

Conclusions The optimised technique not only reduced the workload and storage space, but also facilitated accurate pathological assessment.

  • colorectal neoplasms
  • pathology, surgical
  • diagnosis

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Handling editor Runjan Chetty.

  • ZY and DJ contributed equally.

  • Contributors Study conception design: YH and CX; Data acquisition: ZY, DJ and RL; Data analysis and interpretation: ZY, WH, HW, JS and JL; Writing-original draft preparation: ZY, DJ, WH and HW; Writing-review and editing: YH, CX, RL, JS and JL. YH is responsible for the overall content as the guarantor. All authors read and approved the final manuscript.

  • Funding This work was supported by the Quality control and management system for whole procedure of precision medicine (2017YFC0910003). Shanghai Municipal Commission of Science and Technology (No. 19441904000), Shanghai Municipal Key Clinical Specialty (No. shslczdzk01302) and Shanghai Science and Technology Development Fund (No. 19MC1911000).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.