Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study

Area of Science:

• Gastroenterology
• Surgical Pathology
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive technique for gastric lesion resection.
• Histopathological evaluation of ESD specimens is crucial for diagnosis and treatment planning.
• Nuclear artifacts can complicate the interpretation of gastric ESD specimens.

Purpose of the Study:

• To characterize nuclear artifacts observed in gastric endoscopic submucosal dissection (ESD) specimens.
• To differentiate ESD-related artifacts from true neoplastic changes like dysplasia.
• To identify factors associated with the development of these artifacts.

Main Methods:

• Analysis of 97 gastric ESD specimens from 79 patients.
• Comparison with 69 age- and gender-matched control gastrectomy specimens.
• Histopathological examination for multinucleated figures, atypical mitotic figures, and architectural abnormalities.

Main Results:

• Nuclear artifacts (multinucleated/atypical mitotic figures) were found in 71% of ESD specimens, primarily near marking areas.
• These artifacts mimicked dysplasia in 13 specimens but showed degenerative changes in deeper sections.
• Artifacts were associated with specimen size, marking frequency, and prior marking, but not with aggressive behavior on follow-up.

Conclusions:

• The observed nuclear changes are artifacts related to the ESD procedure and marking.
• These artifacts can be mistaken for dysplasia, particularly in older patients.
• Distinguishing ESD-related artifacts from true dysplasia is essential for accurate diagnosis and patient management.