Reply To: EMR-ESD specimens – public comments

Michael Vieth

Very sound, indeed!
Just some minor remarks :
Page 9ff. Radial margins, deep margins :
In Japan and Europe the terms horizontal (HM) and Vertical (VM) margin is Used. HM and VM Can be ‚0‘ For not Beeing involved, ‚1‘ For beeing involved ; followed by the grade of involvement 1c means cancer at the margin , 1dl means LGD at the margin and 1hl means HGD at the margin (European Guidelines on ESD).
Page 10: instead of stating ‚over-stretching‘ May result in tears ok the margin, I would explicitly state that the specimen should be pinned ‚loosely‘ to the cardboard or cork !
Page 12 (gross exam) : I would recommend to use the updated PARIS classification to describe a lesion as recommended by Japanese and European guidelines also for pathology!
Page 13 : radial margin : See comment above on HM and VM
Bottom of page 13 : photograph : in brackets I would recommend a microscope with reverse light since this enables you to identify the closest margin to the lesion and appropriate later slicing of the specimen.
Page 15 : deep and radial margin : see comment above on HM and VM!
Page 17 : same
Page 20 : other associated histological risk factors: I would like to recommend to name these in detail : eg G3, diffuse type, L1, (V1), budding , perineural Invasion , lymphocytes …. etc …
Page 22: May listing the meaning of m1-m3. Because m1 is HGD , m2 is cancer not reaching the deep muscularis mucosae and m3 is the Invasion Into the Deep Layer of muscularis mucosae. ??
The first description I think was not by Arnulf Hölscher from Cologne but Westerterp et al from the AMC in Amsterdam in December 2004 as far as I remember.

On general : I would recommend to describe budding a little more in detail esp after the consensus in Bern by Alessandro Lugli et al. (Ref 41)
Ref : 38. I would cite the updated PARIS classification consensus in Kyoto. First author Kudo or René Lambert. I think it was two papers, one in GI endoscopy some five years ago or so.
Ref : 41 : the format seems to be a bit corrupted ?
Ref 49 : format
Ref 51-65 volume in bold letters ?
Ref 81 Fujishiro : partly underlined ?
Ref 84 format
Ref 83-88 volume in bold letters ?
Ref 93-94 MB after the pages ?
Ref 102 ‚_‘ in front of Beaton
Ref 100- 114 : Empty spaces in front of first authors ?
Ref 107 : names underlined ?
Ref 112 : brackets erroneously used

On general : sometimes the issue and month and volume is given and sometimes not

All a bit very much in detail but it is nicely written and sound since it covers the whole GI tract and needs to be published !!!!

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