Worldwide variation in pathology reporting of esophageal endoscopic resections: a survey and a literature review

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are central to the diagnosis and treatment of superficial esophageal neoplasia. Accurate pathologic assessment determines endoscopic curability and the need for additional therapy, yet some handling and reporting practices vary internationally. A 19-question web-based survey assessed gross handling, sectioning, depth of invasion, margins, intramucosal carcinoma (IMC) subclassification, synoptic reporting, and prognostically relevant histologic features. We invited gastrointestinal pathologists through professional societies, literature-based contacts, and professional networks. Of 180 respondents, we analyzed 171 who received esophageal endoscopic resection specimens. Respondents practiced in the United States (41%), Canada (10%), Europe (21%), Asia (20%), and Australia/New Zealand (8%); 74% worked in academic settings. Core prognostic elements were reported consistently, including tumor type/grade (99%), depth of invasion (98%), lateral margin status (97%), deep margin status (95%), and lymphovascular invasion (96%). Greater variation involved specimen handling and selected reporting practices. Routine clinician pinning ranged from 91% in Asia to 16% in the United States. 51% used neither the commonly described M-level system for IMC. For submucosal invasion, 48% reported exact depth and 30% used both exact measurement and SM-level classification. Tumor budding was reported by 34% overall and 23% of US respondents. Structured reporting also varied geographically. Pathologists showed broad international agreement in reporting the principal determinants of endoscopic curability, while more focused differences involved specimen handling, invasion terminology, tumor budding, and structured reporting. Harmonization should prioritize reproducible assessment of clinically actionable features rather than uniform adoption of a single regional classification or handling method.