Reply To: EMR-ESD specimens – public comments


This is a nice paper that provides a good overview for handling these specimens. I have several comments.
1. There are a lot of typographical errors throughout the manuscript (e.g. radiall on page 5, verb/noun agreement on page 5, others).
2. The authors advocate pinning out EMR/ESD specimens. While I don’t disagree, maybe they should suggest the person to do the pinning. We often receive shriveled specimens in formalin hours after the procedure.
3. Where are the data to suggest that 2-3 up front levels of every block of an EMR/ESD are necessary? Do they have data suggesting that only one initial level fails to document the lesion and its relationship to margins? If not, I suggest they omit this recommendation. We can always obtain deeper sections based on judgement.
4. The authors seem to use “radial” margin to denote the lateral margin. Maybe they shouldn’t? Some folks may confuse the “radial” margin of an EMR/ESD with the “deep” margin. By convention, we often consider the deep soft tissue margin to be the radial margin elsewhere in the GI tract.
5. The authors should cite references for using ancillary stains to detect vascular invasion.
6. The section on tumor budding could be expanded. We have an opportunity to stop the madness here. I see no compelling evidence to suggest that tumor budding and tumor grade are substantially different concepts, especially if you go back to the days of Haggitt who first evaluated predictive markers in limited excisions. I have never seen a low-grade tumor with high-grade budding. I don’t think it exists if you define grade based on extent of gland differentiation. We could simply say that high-grade tumor (including tumor budding) should warrant high-grade terminology, or something along those lines.
7. Lesion, really? Can’t we call these dysplasias, cancers, or neoplasms? Most of the lesions we are talking about are epithelial neoplasms, aren’t they?

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