切除検体取り扱いの基本

Basics for handling resected specimens

要旨

内視鏡治療において，従来のhot snare polypectomy（HSP），EMRやESDなどの高周波切開凝固装置を用いる治療に加え，近年，高周波切開凝固装置を用いないcold polypectomy（cold snare polypectomy：CSP やcold forceps polypectomy：CFP）が普及してきている。Cold polypectomyでは検体に熱変性が加わらないため，病理学的に腫瘍の存在診断や良悪性の鑑別や異型度の評価といった質的診断が容易である一方で，断端判定や深達度評価がしばしば困難となることが知られている。各内視鏡治療法における利点や欠点を十分に把握し，適切な検体の取り扱いを行うことが正確な病理診断ならびに最適の治療につながるものと考えられる。本稿では，病理学的立場から，内視鏡切除検体の代表的な病理像を提示解説するとともに，正確な病理診断を行うための切除検体の取り扱いにおける心得や留意すべきポイントについて概説したい。

　In endoscopic treatment, in addition to conventional treatments using high-frequency incisional coagulation devices such as hot snare polypectomy (HSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD), cold polypectomy CSP (cold snare polypectomy), and CFP (cold forceps polypectomy), which do not involve electric current, have become widespread in recent years. While cold polypectomy does not cause thermal denaturation of specimens, making it easier to pathologically diagnose the presence of tumors and perform qualitative diagnosis such as differentiation between benign and malignant lesions and assessment of atypia grade, it is known that surgical margin assessment and depth of invasion evaluation are often difficult. A thorough understanding of the advantages and disadvantages of each endoscopic treatment method and appropriate specimen handling are considered to lead to proper pathological diagnosis and treatment. In this section, from a pathological perspective, we would like to explain the basics of specimen handling after specimen collection and to present representative pathological images of each endoscopically resected specimen, and we provide an overview of important considerations and points to note in specimen handling for accurate pathological diagnosis.