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Min L, Qing Y, Chu Y, Liang C, Lv L, Liu D, Tan Y, Zhou Y. Role of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in the Diagnosis of Suspicious Malignant Esophageal Strictures. J Clin Med 2023; 12:jcm12062153. [PMID: 36983155 PMCID: PMC10057162 DOI: 10.3390/jcm12062153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: The accurate diagnosis of esophageal strictures is quite critical for optimizing medical intervention. However, the diagnosis of suspicious malignant esophageal strictures with intact mucosa appearance and negative biopsy results is challenging. This study aimed to evaluate the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis of suspicious esophageal strictures. (2) Methods: We retrospectively analyzed the cases with suspicious malignant esophageal strictures that underwent EUS-FNA, with or without rapid on-site evaluation (ROSE), in our hospital from April 2017 to September 2022. Their clinical manifestations, imaging examinations, gastroscopic examinations, EUS-FNA results, and therapeutic strategies were retrospectively recorded and analyzed. (3) Results: A total of 23 patients (15 male and 8 female) were enrolled in this study. Based on EUS-FNA results, 18 patients were diagnosed with malignancies, including 16 cases of primary esophageal cancer (13 squamous carcinomas and 3 adenocarcinomas), 1 case of mediastinal cancer, and 1 case of metastatic esophageal cancer; 1 case of tuberculosis was also confirmed by EUS-FNA. Among 4 cases of ambiguous diagnosis with EUS-FNA, 1 was diagnosed with an esophageal glomus tumor after surgical removal, and 2 patients survived for several years without medical intervention, which hinted at the possibility of benign esophageal strictures. No major complications, including bleeding or perforation, were observed. (4) Conclusions: EUS-FNA may serve as a safe and effective diagnostic tool in suspicious malignant esophageal strictures with accurate specimen acquisition, especially for biopsy-negative cases.
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Affiliation(s)
- Liang Min
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Yumin Qing
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Yi Chu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
| | - Yuqian Zhou
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
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Li DK, Haffar S, Horibe M, Homsi HA, Zukerberg L, Murad MH, Visrodia KH, Gala M, Katzka DA, Bazerbachi F. Verrucous esophageal carcinoma is a unique indolent subtype of squamous cell carcinoma: a systematic review and individual patient regression analysis. J Gastroenterol 2021; 56:12-24. [PMID: 33079233 DOI: 10.1007/s00535-020-01736-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Verrucous esophageal carcinoma (VEC) is a rare malignancy that presents a diagnostic challenge. We aim to characterize the clinical and genomic features, tumor behavior, and treatment outcomes of VEC to guide clinical practice. METHODS We performed a systematic review of the literature and identified additional cases from Massachusetts General Hospital records and The Cancer Genome Atlas (TCGA). We obtained individual VEC patient data and analyzed publicly available clinicogenomic data from TCGA. We performed a regression analysis comparing cases of VEC to esophageal squamous cell carcinoma (ESCC) to identify factors influencing survival. RESULTS A total of 135 patients were reported in 82 publications, and four unpublished cases from Massachusetts General Hospital (median age 65 years, 69% males, 48% smokers, 33% consumed alcohol). Symptoms were present at diagnosis in 95% of patients, most commonly dysphagia and weight loss. Median symptom onset to diagnosis time was 11.5 months with frequent misdiagnosis as Candida esophagitis. Among VEC cases with pathologic staging, lymph node metastases were rare (5%) compared to ESCC (40%). VEC was genomically characterized by enrichment of SMARCA4 missense mutations and a lack of pathogenic TP53 mutations. Despite its diagnostic elusiveness, in a multivariate regression analysis, VEC was detected at earlier stages (p = < 0.001) compared to ESCC, and advanced stage was the only significant factor affecting survival (p = 0.013). CONCLUSIONS VEC is a rare, clinically and genomically distinct subtype of ESCC. Recognition and diagnosis of this lesion may allow the pursuit of curative and less morbid treatment strategies.
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Affiliation(s)
- Darrick K Li
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Samir Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Haya A Homsi
- School of Public Health, University of Waterloo, Waterloo, ON, Canada
| | - Lawrence Zukerberg
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad H Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kavel H Visrodia
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Manish Gala
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
- Assistant in Medicine, Instructor in Medicine, Harvard Medical School, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 825D, Boston, MA, 02114, USA.
| | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Fateh Bazerbachi
- Assistant in Medicine, Instructor in Medicine, Harvard Medical School, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 825D, Boston, MA, 02114, USA.
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Dahale AS, Srivastava S, Sonika U, Dalal A, Goyal A, Sakhuja P, Sachdeva S, Puri AS. Role of linear endosonography in the diagnosis of biopsy-negative malignant esophageal strictures: Exploring the unexplored. JGH OPEN 2019; 4:113-116. [PMID: 32280752 PMCID: PMC7144779 DOI: 10.1002/jgh3.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
Background and Aim Endoscopic biopsy is standard for the diagnosis of esophageal malignancy. However, few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in the diagnosis of biopsy-negative suspected malignant esophageal strictures. Methods We retrospectively analyzed the data from August 2017 to December 2018 of biopsy-negative esophageal strictures. All adult patients with twice-negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Clinical, epidemiological, endoscopic, imaging, and EUS findings were noted and analyzed. Results Eighteen patients underwent EUS for suspicion of malignant esophageal stricture. Seven were excluded as they were submucosal tumors. Eleven patients showed the presence of malignancy on EUS FNA samples. Nine were males. Computed tomography showed esophageal wall thickening in eight (16-38 mm) and esophageal mass in three patients. EUS showed loss of a normal five-layered wall structure of the esophagus in all patients. Fine-needle aspiration cytology demonstrated squamous cell carcinoma (n = 4), adenocarcinoma (n = 4), poorly differentiated carcinoma (n = 2), and neuroendocrine carcinoma (n = 1). There were no complications. Conclusion EUS with FNA is effective and safe for the diagnosis of biopsy-negative malignant esophageal strictures.
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Affiliation(s)
- Amol S Dahale
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Siddharth Srivastava
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Ashok Dalal
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Aditi Goyal
- Department of Pathology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Puja Sakhuja
- Department of Pathology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Sanjeev Sachdeva
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Amarender S Puri
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
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