Читать книгу Gastrointestinal Pathology - Группа авторов - Страница 34

Endoscopic resection methods of flat and lateral spreading colorectal polyps has expanded rapidly over last 10 years. Most noninvasive neoplastic lesions of the colon can now be removed through advanced endoscopic methods such as EMR or ESD avoiding the need for surgery. Lesions less than 2 cm can typically be removed en bloc with endoscopic mucosal resection involving injection of a fluid cushion under the lesion followed by snare resection. Where there is suspected early (mucosal or superficial submucosal) invasive carcinoma, en bloc resection should be performed using either EMR or ESD depending on the size of the lesion. The tissue processing should be the same as for other neoplastic lesions with orientation of the specimen and pinning of the specimen to assess the lateral and deep margins (Figure 1.14).

The final histological analysis allows for detailed staging, as well as matching the corresponding histological and endoscopic findings; note the lavender line overlays indicating sites of advanced neoplasia. The close collaboration between pathologists and endoscopists further improves the accuracy of each procedure (Figure 1.15).