Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2025; 17(3): 101525
Published online Mar 16, 2025. doi: 10.4253/wjge.v17.i3.101525
Establishing and popularizing a standard pathological diagnostic model of endoscopic submucosal dissection specimens in China
Chun Xu, Ling Chen, An-Ning Feng, Ling Nie, Yao Fu, Lin Li, Wei Li, Qi Sun
Chun Xu, Ling Chen, An-Ning Feng, Ling Nie, Yao Fu, Lin Li, Wei Li, Qi Sun, Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Co-first authors: Chun Xu and Ling Chen.
Author contributions: Xu C and Chen L contribute equally to this study as co-first authors; Sun Q and Feng AN designed the study and the questionnaires; Xu C, Chen L, and Feng AN gathered and analyzed the data and drafted the manuscript; Sun Q and Xu C contributed to revising the manuscript; Nie L, Fu Y, Li L, and Li W participated in the delivery of the training course; all the authors participated in the discussion and modification of the questionnaires; all the authors have read and agreed to the submission of the final manuscript.
Supported by the Medical Education Research Project from Nanjing Drum Tower Hospital, No. 2021-7; the Clinical Trials Fund from Nanjing Drum Tower Hospital, No. 2022-YXZX-XH-04; and National Natural Science Foundation of China, No. 82203063.
Institutional review board statement: This study was approved by the Ethics Committee of Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University. All the procedures in this survey were carried out following the approved guidelines and regulations.
Informed consent statement: All the participants were informed about the purpose of this survey, and this information was given in oral form. Participation was voluntary and onymous.
Conflict-of-interest statement: The authors declare that they have no conflicts of interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: sharing statement: The questionnaires and datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Sun, MD, Associate Chief Physician, Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Gulou District, Nanjing 210008, Jiangsu Province, China. sunqi@njglyy.com
Received: September 18, 2024
Revised: December 14, 2024
Accepted: February 8, 2025
Published online: March 16, 2025
Processing time: 177 Days and 2.4 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) is a standardized therapeutic approach for early carcinoma of the digestive tracts. In this regard, the process of histopathological diagnosis requires standardization. However, the uneven development of healthcare in China, especially in eastern and western China, creates challenges for sharing a standardized diagnostic process.

AIM

To optimize the process of ESD specimen sampling, embedding and slide production, and to provide complete and accurate pathological reports.

METHODS

We established a practical process of specimen sampling, created standardized reporting templates, and trained pathologists from neighboring hospitals and those in the western region. A training effectiveness survey was conducted, and the collected data were assessed by the corresponding percentages.

RESULTS

A total of 111 valid feedback forms have been received, among which 58% of the participants obtained photographs during specimen collection, whereas the percentage increased to 79% after training. Only 58% and 62% of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged; after training, these two proportions increased to 95% and 92%, respectively. Approximately half the participants measured the depth of the submucosal infiltration, which significantly increased to 95% after training. The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced. Only 22% of the participants had fixed clinic-pathological meetings before training, which increased to 49% after training. The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.

CONCLUSION

There have been significant improvements in the process of specimen collection, section quality, and pathology reporting in trained hospitals. Therefore, our study provides valuable insights for others facing similar challenges.

Keywords: Endoscopic submucosal dissection specimen; Specimen processing; Pathological diagnosis; Gastrointestinal endoscopy; Continuing education

Core Tip: The uneven development of healthcare in China creates challenges for sharing a standardized diagnostic process of endoscopic submucosal dissection (ESD) specimens. Therefore, we established and popularized a standard and practical process of specimen sampling and diagnosis of ESD specimens. The feedback survey revealed significant improvements in the standardized specimen processing and collection, pathological section quality, and pathology report standardization in trained hospitals. Therefore, our study is not only applicable in China, but also in any country performing ESD.