| Sample Type | Grade I recommendations | Grade II recommendations | Grade III recommendations | |
|---|---|---|---|---|
| Gross examination | Light microscopic examination | |||
| Biopsy specimen* | Record the size and number of tissues biopsied | Identify the nature and histological type of the lesion Cancerous/non-cancerous Benign/malignant Histological subtype |
Detect immunohistochemical markersm: used for differential diagnosis of histological subtypes, confirmation of vascular and lymphatic invasion, evaluation of tumor cell proliferation activity, etc | Evaluate the presence of HP infectionn (Evidence 1B) |
| Endoscopic resection specimena (EMR/ESD) | Tumor siteb Tumor size (cm3) |
Intra-epithelial neoplasia/adenomatous grade (high grade) Invasive carcinoma Histological subtyped/Lauren classificatione Histological grade (G1, G2, G3) Depth of infiltration Horizontal distal margin and deepest infiltration margin Vascular and lymphatic invasion |
Same as above The general type of early-stage gastric cancerk |
Same as above |
| Surgical resection specimens for those without neoadjuvant therapy | Type of the surgical specimen Tumor site Tumor size (cm3) The distance of the tumor lesion from the lateral edge of the mouth/anus The stations and number and of lymph nodes retrieved (At least 16 lymph nodes and/or preferentially > 30 lymph nodes to be retrieved)c |
Histological subtype/Lauren classification Histological grade (G1, G2, G3) Depth of invasion (pT classification)f Vascular, lymphatic, and nerve invasion Margin lateral to the mouth/anusg Invasion to the esophagus/duodenum (if resected) Number of lymph node metastases/number of lymph nodes retrieved (pN classification) Number of cancer nodulesh Distant metastasis (pM stage)i pTNM staging of gastric cancer (8th AJCC/UICC edition)b |
Same as above General type of progressive gastric cancerl |
Same as above |
| Surgical resection specimens for those who had neoadjuvant therapy | Same as above (for specimens with no obvious tumors, careful examination and multipoint sampling should be made to avoid misdiagnosis of response to tumor therapy and clinicopathological stage) | Same as above Tumor regression grade (TRG)j ypTNM stage (8th AJCC/UICC edition) |
Same as above | Same as above |
* For non-resectable lesions, the cytological assessment of ascites and pleural effusion and biopsy of the distant metastatic lesion should be conducted as routinely performed