J Dig Cancer Res.  2023 Apr;11(1):15-20. 10.52927/jdcr.2023.11.1.15.

Pathological Interpretation of Gastric Tumors in Endoscopic Submucosal Dissection

• Kim JY

• KMID: 2541623
• DOI: http://doi.org/10.52927/jdcr.2023.11.1.15

Abstract

Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for early gastric cancer. The criteria for determining the suitability and success of ESD have expanded, with changes in the histopathological classification of gastric carcinoma, including results from molecular research. Treatment methods have also diversified to include targeted therapies and immuno-oncology agents. To improve communication between clinicians and pathologists, it is crucial to understand the standardized diagnostic forms of gastric cancer. This study aims to examine the handling method of ESD specimens and describe the pathological findings of gastric tumors.

Keyword

Endoscopic submucosal dissection; Pathology; Diagnosis

Reference

1. Jung KW, Won YJ, Hong S, Kong HJ, Im JS, Seo HG. 2021; Prediction of cancer incidence and mortality in Korea, 2021. Cancer Res Treat. 53:316–322. https://doi.org/10.4143/crt.2021.290. DOI: 10.4143/crt.2021.290. PMID: 33735558. PMCID: PMC8053854.

2. Hatta W, Gotoda T, Oyama T, et al. 2017; A scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: "eCura system". Am J Gastroenterol. 112:874–881. https://doi.org/10.1038/ajg.2017.95. Erratum in: Am J Gastroenterol 2019;114:1925-1926. https://doi.org/10.14309/ajg.0000000000000432. DOI: 10.14309/ajg.0000000000000432. PMID: 31658102.

3. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. 2019; Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 19:1–48. https://doi.org/10.5230/jgc.2019.19.e8. Erratum in: J Gastric Cancer 2019;19:372-373. https://doi.org/10.5230/jgc.2019.19.e32. DOI: 10.5230/jgc.2019.19.e32. PMID: 31598379. PMCID: PMC6769366.

4. Kushima R. 2022; The updated WHO classification of digestive system tumours-gastric adenocarcinoma and dysplasia. Pathologe. 43:8–15. https://doi.org/10.1007/s00292-021-01023-7. DOI: 10.1007/s00292-021-01023-7. PMID: 34807275.

5. WHO Classification of Tumours Editorial Board. 2019. WHO classification of tumours/digestive system tumours. WHO;Geneva: DOI: 10.1002/9781118695647.ch2.

6. Muro K, Chung HC, Shankaran V, et al. 2016; Pembrolizumab for patients with PD-L1-positive advanced gastric cancer (KEYNOTE-012): a multicentre, open-label, phase 1b trial. Lancet Oncol. 17:717–726. https://doi.org/10.1016/S1470-2045(16)00175-3. DOI: 10.1016/S1470-2045(16)00175-3. PMID: 27157491.

7. Bang YJ, Van Cutsem E, Feyereislova A, et al. 2010; Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 376:687–697. Erratum in: Lancet 2010;376:1302. DOI: 10.1016/S0140-6736(10)61121-X. PMID: 20728210.

8. Park YS, Kook MC, Kim BH, et al. 2023; A standardized pathology report for gastric cancer: 2nd edition. J Pathol Transl Med. 57:1–27. https://doi.org/10.4132/jptm.2022.12.23. DOI: 10.4132/jptm.2022.12.23. PMID: 36647283. PMCID: PMC9846007. PMID: 28c9b54dfd1c4587b6cf9cf29e9e5170.

9. Seo HS, Lee GE, Kang MG, Han KH, Jung ES, Song KY. 2019; Mixed histology is a risk factor for lymph node metastasis in early gastric cancer. J Surg Res. 236:271–277. https://doi.org/10.1016/j.jss.2018.11.055. DOI: 10.1016/j.jss.2018.11.055. PMID: 30694766.

10. Horiuchi Y, Ida S, Yamamoto N, et al. 2020; Feasibility of further expansion of the indications for endoscopic submucosal dissection in undifferentiated-type early gastric cancer. Gastric Cancer. 23:285–292. https://doi.org/10.1007/s10120-019-01003-0. DOI: 10.1007/s10120-019-01003-0. PMID: 31486980.

11. Lee IS, Lee S, Park YS, Gong CS, Yook JH, Kim BS. 2017; Applicability of endoscopic submucosal dissection for undifferentiated early gastric cancer: mixed histology of poorly differentiated adenocarcinoma and signet ring cell carcinoma is a worse predictive factor of nodal metastasis. Surg Oncol. 26:8–12. https://doi.org/10.1016/j.suronc.2016.12.001. DOI: 10.1016/j.suronc.2016.12.001. PMID: 28317588.

12. Guo CG, Zhao DB, Liu Q, et al. 2015; Risk factors for lymph node metastasis in early gastric cancer with signet ring cell carcinoma. J Gastrointest Surg. 19:1958–1965. https://doi.org/10.1007/s11605-015-2915-z. DOI: 10.1007/s11605-015-2915-z. PMID: 26302875.

13. Kim YH, Park JH, Park CK, et al. 2017; Histologic purity of signet ring cell carcinoma is a favorable risk factor for lymph node metastasis in poorly cohesive, submucosa-invasive early gastric carcinoma. Gastric Cancer. 20:583–590. https://doi.org/10.1007/s10120-016-0645-x. DOI: 10.1007/s10120-016-0645-x. PMID: 27663439.

14. Ma DW, Lee SJ, Kook MC, et al. 2020; The suggestion of revised criteria for endoscopic resection of differentiated-type submucosal gastric cancer. Ann Surg Oncol. 27:795–801. https://doi.org/10.1245/s10434-019-08102-3. DOI: 10.1245/s10434-019-08102-3. PMID: 31828690.

15. Choi JY, Park YS, Jung HY, et al. 2015; Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach. Surg Endosc. 29:1476–1483. https://doi.org/10.1007/s00464-014-3828-8. DOI: 10.1007/s00464-014-3828-8. PMID: 25249150.

16. Choi IJ, Kook MC, Kim YI, et al. 2018; Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med. 378:1085–1095. https://doi.org/10.1056/NEJMoa1708423. DOI: 10.1056/NEJMoa1708423. PMID: 29562147.

17. Ono H, Yao K, Fujishiro M, et al. 2021; Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc. 33:4–20. https://doi.org/10.1111/den.13883. DOI: 10.1111/den.13883. PMID: 33107115.

18. Cancer Genome Atlas Research Network. 2014; Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 513:202–209. https://doi.org/10.1038/nature13480. DOI: 10.1038/nature13480. PMID: 25079317. PMCID: PMC4170219.

19. Cristescu R, Lee J, Nebozhyn M, et al. 2015; Molecular analysis of gastric cancer identifies subtypes associated with distinct clinical outcomes. Nat Med. 21:449–456. https://doi.org/10.1038/nm.3850. DOI: 10.1038/nm.3850. PMID: 25894828.

20. Van Cutsem E, Bang YJ, Feng-Yi F, et al. 2015; HER2 screening data from ToGA: targeting HER2 in gastric and gastroesophageal junction cancer. Gastric Cancer. 18:476–484. https://doi.org/10.1007/s10120-014-0402-y. DOI: 10.1007/s10120-014-0402-y. PMID: 25038874. PMCID: PMC4511072.

21. Lee HE, Park KU, Yoo SB, et al. 2013; Clinical significance of intratumoral HER2 heterogeneity in gastric cancer. Eur J Cancer. 49:1448–1457. https://doi.org/10.1016/j.ejca.2012.10.018. DOI: 10.1016/j.ejca.2012.10.018. PMID: 23146959.

22. Kim MA, Lee HJ, Yang HK, Bang YJ, Kim WH. 2011; Heterogeneous amplification of ERBB2 in primary lesions is responsible for the discordant ERBB2 status of primary and metastatic lesions in gastric carcinoma. Histopathology. 59:822–831. https://doi.org/10.1111/j.1365-2559.2011.04012.x. DOI: 10.1111/j.1365-2559.2011.04012.x. PMID: 22092393. PMCID: PMC3267049.

23. Kochi M, Fujii M, Masuda S, et al. 2013; Differing deregulation of HER2 in primary gastric cancer and synchronous related metastatic lymph nodes. Diagn Pathol. 8:191. https://doi.org/10.1186/1746-1596-8-191. DOI: 10.1186/1746-1596-8-191. PMID: 24261710. PMCID: PMC3937244.

24. Ahn S, Lee SJ, Kim Y, et al. 2017; High-throughput protein and mRNA expression-based classification of gastric cancers can identify clinically distinct subtypes, concordant with recent molecular classifications. Am J Surg Pathol. 41:106–115. https://doi.org/10.1097/PAS.0000000000000756. DOI: 10.1097/PAS.0000000000000756. PMID: 27819872.

25. Choi YY, Kim H, Shin SJ, et al. 2019; Microsatellite instability and programmed cell death-ligand 1 expression in stage II/III gastric cancer: post hoc analysis of the CLASSIC randomized controlled study. Ann Surg. 270:309–316. https://doi.org/10.1097/SLA.0000000000002803. DOI: 10.1097/SLA.0000000000002803. PMID: 29727332.

26. Le DT, Durham JN, Smith KN, et al. 2017; Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 357:409–413. https://doi.org/10.1126/science.aan6733. DOI: 10.1126/science.aan6733. PMID: 28596308. PMCID: PMC5576142.

27. Park JH, Kim EK, Kim YH, et al. 2016; Epstein-Barr virus positivity, not mismatch repair-deficiency, is a favorable risk factor for lymph node metastasis in submucosa-invasive early gastric cancer. Gastric Cancer. 19:1041–1051. https://doi.org/10.1007/s10120-015-0565-1. DOI: 10.1007/s10120-015-0565-1. PMID: 26573601.

28. Cheng Y, Zhou X, Xu K, Huang J, Huang Q. 2020; Very low risk of lymph node metastasis in Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma. BMC Gastroenterol. 20:273. https://doi.org/10.1186/s12876-020-01422-9. DOI: 10.1186/s12876-020-01422-9. PMID: 32807085. PMCID: PMC7433105. PMID: 60b1bb13a0c245fea651bb095804dc92.

29. Kim ST, Cristescu R, Bass AJ, et al. 2018; Comprehensive molecular characterization of clinical responses to PD-1 inhibition in metastatic gastric cancer. Nat Med. 24:1449–1458. https://doi.org/10.1038/s41591-018-0101-z. DOI: 10.1038/s41591-018-0101-z. PMID: 30013197.

30. Fuchs CS, Doi T, Jang RW, et al. 2018; Safety and efficacy of pembrolizumab monotherapy in patients with previously treated advanced gastric and gastroesophageal junction cancer: phase 2 clinical KEYNOTE-059 trial. JAMA Oncol. 4:5. e180013. Erratum in: JAMA Oncol 2019;5:579. DOI: 10.1001/jamaoncol.2019.0286. PMID: 29543932. PMCID: PMC5885175.

31. Janjigian YY, Shitara K, Moehler M, et al. 2021; First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 398:27–40. https://doi.org/10.1016/S0140-6736(21)00797-2. DOI: 10.1016/S0140-6736(21)00797-2. PMID: 34102137.