Esophageal cancer can be divided into squamous and adenocarcinoma depending on the type of tissue, and they all have different triggers, malignancy, and treatment. The pathological biopsy can clarify, which type of esophageal cancer you have. It is not only the gold standard for confirming the diagnosis of esophageal cancer, but also a reliable basis for formulating treatment plans.
What is a pathologic biopsy?
A biopsy, also known as a biopsy or pathology, is a biopsy. A biopsy is a procedure in which tissue is removed from a patient’s body and sent to the pathology department through endoscopy, fine needle aspiration, or surgical excision by cutting, clamping, or aspiration. The pathologist observes the lesioned tissue under a microscope for abnormalities and evaluates the morphological size and tissue type of the lesion.
Pathologic biopsies for esophageal cancer are typically obtained during gastroscopy using biopsy forceps to obtain lesion tissue. The vast majority of samples sent for examination yield a definitive histopathologic diagnosis. However, there are some samples that are too small in volume and inaccurate in location to reach a definitive conclusion and require waiting for more and more accurate lesion tissue to be obtained after surgery for a final pathologic diagnosis.
Gastroscopy precautions and procedures are described in detail in:
What are the steps of pathology biopsy?
1. Fixation: The removed sample is fixed in a 10% formalin solution and sent to the pathology department.
2. Initial observation: After the pathologist receives the specimen, he or she will first observe the appearance, color, size, shape, and texture of the tissue with the naked eye.
3. Production: The physician makes a “readable” pathology section of the specimen to facilitate microscopic observation of fine tissue structure and cell morphology. The process is complex, including fixation, extraction, dehydration, wax immersion, embedding, sectioning, staining, sealing, and other tedious steps. Each step may take several hours and typically takes 2 to 3 days to complete.
4. Reading: Once the specimen is ready, it is time to “read” it. In order to make the diagnosis more accurate, there are two steps: diagnosis by the junior doctor and review and correction by the senior doctor.
What is on the pathology report?
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1. The site and amount of tissue sent for examination
The main description is what can be seen with the naked eye, including the size of the tissue sent for examination, whether the tumor is visible in the cut surface and the number, size, color, texture, whether the boundary with the surrounding normal tissue is clear and the color and texture of the normal tissue.
2. Methods of staining
In most cases, plain staining can only yield preliminary pathologic results and cannot accurately typify the tissue cells or determine the origin of the tissue, which requires immunohistochemical staining (“immunohistochemistry”).
What is immunohistochemistry?
What is immunohistochemistry? Any cell can secrete specific proteins that serve as its own “identity”. The antibody-antigen reaction occurs when tissue cells are treated with certain antibodies that bind to the corresponding “identifiers” (i.e., antigens), like the positive and negative poles of a magnet attracting each other. This is then displayed by a chromogenic agent, which can be used to determine the origin of the tissue or cell type.
3. Characteristics of microscopic histocytology
Microscopic morphology, which primarily includes the histologic typing, differentiation, and growth pattern of the tumor.
The histological staging of esophageal cancer is mainly squamous and adenocarcinoma.
The degree of differentiation can be classified from mild to severe as grade I (highly differentiated), grade II (moderately differentiated), and grade III (poorly differentiated). The higher the degree of differentiation, the better the treatment outcome in general.
Growth patterns include peri-cancerous infiltration, envelope invasion or breakthrough, and microvascular invasion, which are important predictors of postoperative recurrence risk.
4. Pathological diagnosis
The pathologist determines the type of tumor and the degree of differentiation based on the morphology and distribution of the lesioned tissue cells under the microscope.
Usually, you can complete the pathology biopsy on an outpatient basis and get the pathology report in about 3 to 5 days. The exact time frame is affected by the amount of samples available at each hospital and the number of staff in the pathology department. You must keep the pathology report form because it is the most fundamental basis for diagnosing esophageal cancer and formulating treatment plan.