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Huang Q, Shi J, Liu TY, Cheng YQ, Wang YH, Du MZ, Li L, Fan XS, Zhou XL, Zhang YF, Guo LC, Xu GF, Zou XP. Marked thickening of muscularis mucosae and submucosa in the gastric cardia: A histopathological study of 110 surgical resection cases. J Dig Dis 2020; 21:205-214. [PMID: 32223013 DOI: 10.1111/1751-2980.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate histopathologic changes of muscularis mucosae (MM) and submucosa in the gastric cardia. METHODS We performed a histopathology study of 50 distal esophagectomies with proximal gastrectomies for esophageal squamous cell carcinoma as the study (non-cancerous cardiac) group and 60 gastrectomies for early gastric cardiac carcinoma as the cancer group. The gastroesophageal junction was defined as the distal end of squamous epithelium, multilayered epithelium, or deep esophageal glands or ducts. Gastric cardia (n = 110) was defined as the presence of cardiac and cardio-oxyntic mucosae distal to the gastroesophageal junction. RESULTS The average thickness of MM and submucosa in the cardia was 1.04 and 1.41 mm, respectively, which was significantly thicker than that in distal stomach (n = 34) (0.22 and 0.99 mm) or distal esophagus (n = 92) (0.60 and 1.15 mm). In the cardia, thickened MM displayed frayed muscle fibers (93.3%) with a significantly higher prevalence of entrapped glands, cysts, and lymphoid follicles than in the distal stomach or distal esophagus. In the submucosa fatty changes, cysts, and abnormal arteries were significantly more common in the cardia than in the distal stomach or distal esophagus. Compared with the study group, the cardia in the cancer group showed significantly thicker MM (average 1.31 vs 0.72 mm) and submucosa (average 1.61 vs 1.16 mm), more frequent frayed MM (93.3% vs 60.0%), prolapse-like changes (50.0% vs 2.0%), and cysts (26.7% vs 4.0%). CONCLUSION MM and submucosa of the cardia were significantly thickened, especially in early gastric cardiac carcinomas.
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Affiliation(s)
- Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China.,Department of Pathology and Laboratory Medicine, VA Boston Healthcare System and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Tian Yun Liu
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yu Qing Cheng
- Department of Pathology, Changzhou Second Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yao Hui Wang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing Medical University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ming Zhan Du
- Department of Pathology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lin Li
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiang Shan Fan
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiao Li Zhou
- Department of Pathology, Changzhou Second Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi Fen Zhang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing Medical University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ling Chuan Guo
- Department of Pathology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gui Fang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
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2
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Standardised reporting protocol for endoscopic resection for Barrett oesophagus associated neoplasia: expert consensus recommendations. Pathology 2016; 46:473-80. [PMID: 25158823 DOI: 10.1097/pat.0000000000000160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopic resection (ER) is considered the therapy of choice for intraepithelial neoplasia associated with visible lesions and T1a adenocarcinoma. Pathologists are bound to encounter specimens collected via these techniques more frequently in their practice. A standardised protocol for handling, grossing, and assessing ER specimens should be adopted to ensure that all prognostic information and characteristics influencing treatment are included in reports (see Supplementary Video Abstract, http://links.lww.com/PAT/A22). The entire specimen should be appropriately oriented, processed and assessed. An ER specimen will commonly show intraepithelial neoplasia or invasive carcinoma. There are essential features that should be recorded if invasive carcinoma is found as they dictate further management and follow-up. These features are the margin status, depth of invasion, degree of differentiation and presence or absence of lymphovascular invasion. Important features such as duplication of muscularis mucosae should be recognised to avoid misinterpretation of depth of invasion. Key diagnostic and prognostic elements that are essential for optimal clinical decisions have been included in the reporting format proposed by the Structured Pathology Reporting committee of the Royal College of Pathologists of Australasia (RCPA).
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Thota PN, Sada A, Sanaka MR, Jang S, Lopez R, Goldblum JR, Liu X, Dumot JA, Vargo J, Zuccarro G. Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett's esophagus with high-grade dysplasia and early cancer. Surg Endosc 2016; 31:1336-1341. [PMID: 27444824 DOI: 10.1007/s00464-016-5117-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/12/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor. METHODS This is a retrospective review of patients referred to endoscopic therapy of BE with HGD or early esophageal adenocarcinoma (EAC) who underwent EMR from 2006 to 2011. Age, race, sex, length of Barrett's segment, hiatal hernia size, number of endoscopies and biopsy results and EUS findings were abstracted. RESULTS A total of 151 patients underwent EMR. In 50 % (75/151) of patients, EMR histology was consistent with endoscopic forceps biopsy findings. EMR resulted in change in diagnosis with upstaging in 21 % (32/151) and downstaging in 29 % (44/151). In patients with HGD on EMR, EUS staging was T0 in 74.1 % (23/31) but upstaged in 25.8 % (8/31). In patients with IMC on EMR, EUS findings were T1a in 23.6 % (9/38), upstaged in 18.4 % (7/38) and downstaged in 57.8 % (22/38). EUS accurately identified EMR histology in all submucosal cancers. Grade of differentiation was reported in 24 cancers on EMR histology. There was no correlation between grade and EUS staging. CONCLUSIONS EUS is of limited utility in accurate staging of BE patients with HGD or early EAC. Endoscopic forceps biopsy correlated with EMR findings in only 50 % of patients. Irrespective of the endoscopic forceps biopsy results, all BE patients with visible lesions should be referred to EMR.
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Affiliation(s)
- Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Alaa Sada
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Rocio Lopez
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - John R Goldblum
- Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA
| | - Xiuli Liu
- Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA
| | - John A Dumot
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Gregory Zuccarro
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
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Mohiuddin K, Dorer R, El Lakis MA, Hahn H, Speicher J, Hubka M, Low DE. Outcomes of Surgical Resection of T1bN0 Esophageal Cancer and Assessment of Endoscopic Mucosal Resection for Identifying Low-Risk Cancers Appropriate for Endoscopic Therapy. Ann Surg Oncol 2016; 23:2673-8. [PMID: 27020584 DOI: 10.1245/s10434-016-5138-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Invasive esophageal cancers have been managed historically with esophagectomy. Low-risk T1b patients are being proposed for nonsurgical management. The purpose of this study was to evaluate the ability of endoscopic mucosal resections (EMR) to identify low-risk T1b patients and to review surgical treatment outcomes for T1b cancer. METHODS All esophageal cancer patients, in an institutional review board-approved prospective database, between 2000 and 2013 with clinical stage (cT1bN0), pathological stage (pT1bN0), and no neoadjuvant therapy were retrospectively reviewed. RESULTS Fifty-one patients, 38 pT1b and 13 cT1b, were assessed. All cT1b had preoperative EMR and five were found to be understaged at esophagectomy. pT1bN0 patients had a mean age of 66 years, mean BMI of 30, and 95 % had adenocarcinoma. Thirty-eight pT1bN0 patients underwent esophagectomy with a median hospital length of stay (LOS) of 9 days. Complications occurred in 14 patients, but 71 % were minor (Accordion score 1-2). In-hospital 30- and 90-day mortality was zero. EMR specimens were re-reviewed to assess low-risk criteria. Degree of differentiation and the presence of lymphovascular invasion could be assessed in all EMR specimens; however, assessment of submucosal invasion limited to the superficial submucosal layer could not be determined in the majority of cases. Kaplan-Meier 5-year overall survival in pT1bN0 patients was 78.7 %. CONCLUSIONS Clinical staging of superficial esophageal cancer can be inaccurate especially in submucosal tumors. EMR should be routinely used for preoperative staging. Healthy patients with clinical tumor stage greater than cT1a should undergo multidisciplinary review and be considered for surgical resection.
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Affiliation(s)
- Kamran Mohiuddin
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Russell Dorer
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Mustapha A El Lakis
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Hejin Hahn
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - James Speicher
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
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5
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Khanna LG, Gress FG. Preoperative evaluation of oesophageal adenocarcinoma. Best Pract Res Clin Gastroenterol 2015; 29:179-91. [PMID: 25743465 DOI: 10.1016/j.bpg.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 01/31/2023]
Abstract
The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection. In contrast, in advanced oesophageal cancers, a multi-modality approach is crucial. Accurate tumour staging is very important since the treatment of advanced cancers involves a combination of chemotherapy, radiation, and surgery. EUS is very useful for staging of the tumour and nodes. High frequency ultrasound miniprobes provide the ability to perform staging when the lesion is obstructing the oesophageal lumen. CT and PET provide valuable information regarding node and metastasis staging.
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Affiliation(s)
- Lauren G Khanna
- Division of Digestive & Liver Diseases, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
| | - Frank G Gress
- Division of Digestive & Liver Diseases, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion 13, New York, NY 10032, USA.
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6
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Al-Haddad S, Chang AC, De Hertogh G, Grin A, Langer R, Sagaert X, Salemme M, Streutker CJ, Soucy G, Tripathi M, Upton MP, Vieth M, Villanacci V. Adenocarcinoma at the gastroesophageal junction. Ann N Y Acad Sci 2014; 1325:211-25. [DOI: 10.1111/nyas.12535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sahar Al-Haddad
- Department of Laboratory Medicine and Pathobiology; St. Michael's Hospital; Toronto Canada
| | - Andrew C. Chang
- Section of Thoracic Surgery; University of Michigan Medical Center; Ann Arbor Michigan
| | - Gert De Hertogh
- Department of Morphology and Molecular Pathology; University Hospitals of K.U. Leuven; Leuven Belgium
| | | | - Rupert Langer
- Institute of Pathology; University of Bern; Bern Switzerland
| | - Xavier Sagaert
- Department of Morphology and Molecular Pathology; University Hospitals of K.U. Leuven; Leuven Belgium
| | | | - Catherine J. Streutker
- Department of Laboratory Medicine and Pathobiology; St. Michael's Hospital; Toronto Canada
| | - Geneviève Soucy
- Département de Pathologie - Pathologie Gastro-intestinale; Centre Hospitalier de l'Université de Montréal; Montréal Canada
| | - Monika Tripathi
- Department of Cellular Pathology; Oxford University Hospitals NHS Trust; Oxford United Kingdom
| | - Melissa P. Upton
- Department of Pathology; University of Washington; Seattle Washington
| | - Michael Vieth
- Institute of Pathology; Klinikum Bayreuth; Bayreuth Germany
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7
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Abstract
The incidence of esophageal adenocarcinoma and associated mortality has risen dramatically over the past several decades, and, thus, it is increasingly important to understand its pathogenesis and risk factors. Barrett esophagus is the established precursor to esophageal adenocarcinoma that progresses through a metaplasia-dysplasia-carcinoma sequence. Its risk of transforming to carcinoma is not as high as previously reported and there appears to be a biological heterogeneity among patients with this disease. The overall prevalence of Barrett esophagus in the United States ranges from 1% to 25% and is closer to 5% in patients with gastroesophageal reflux disease. Because of the frequency of Barrett esophagus and associated implications, it is important for the practicing pathologist to have a thorough understanding of this disease and its diagnostic pitfalls. In this review, we will discuss issues associated with the diagnosis of Barrett esophagus, including the definition of Barrett esophagus and its distinction from carditis with intestinal metaplasia. We will also discuss challenges in the grading of dysplasia and new variants of dysplasia, including crypt dysplasia and foveolar-type dysplasia. Finally, we will touch upon the evaluation of dysplasia in endoscopic mucosal resection specimens.
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Affiliation(s)
- Catherine E Hagen
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Gregory Y Lauwers
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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8
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Grin A, Streutker CJ. Histopathology in barrett esophagus and barrett esophagus-related dysplasia. Clin Endosc 2014; 47:31-9. [PMID: 24570881 PMCID: PMC3928489 DOI: 10.5946/ce.2014.47.1.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/14/2013] [Indexed: 12/22/2022] Open
Abstract
Pathologic specimens, both biopsies and endoscopic mucosal resections, for Barrett esophagus and Barrett-associated dysplasia and malignancy are common for pathologists in North America, and the incidence in South Asian countries seems to be increasing. Dysplasia and malignancy arising in intestinalized gastric-type mucosa raises issues in the interpretation of dysplasia and the evaluation of the depth of invasion of malignancies that are not seen in squamous dysplasia and squamous cell carcinoma. We review the North American approach to these lesions.
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Affiliation(s)
- Andrea Grin
- Division of Pathology, Department of Laboratory Medicine, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, the University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Catherine J Streutker
- Division of Pathology, Department of Laboratory Medicine, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, the University of Toronto Faculty of Medicine, Toronto, ON, Canada
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9
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Bronner MP. Barrett's Esophagus. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2014. [DOI: 10.7704/kjhugr.2014.14.3.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mary P. Bronner
- Division of Anatomic Pathology & Molecular Oncology, University of Utah and ARUP Laboratories, Huntsman Cancer Institute, Salt Lake City, UT, USA
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10
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Bergeron EJ, Lin J, Chang AC, Orringer MB, Reddy RM. Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg 2013; 147:765-71: Discussion 771-3. [PMID: 24314788 DOI: 10.1016/j.jtcvs.2013.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 10/01/2013] [Accepted: 10/11/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Esophageal endoscopic ultrasound is now regarded as essential in the staging of esophageal carcinoma. There is an increasing trend toward endoluminal therapies (ie, endoscopic mucosal resection and radiofrequency ablation) for pre-cancer or early-stage cancers because of concerns of high morbidity associated with esophagectomy. This study reviews our institutional experience with preoperative endoscopic ultrasound staging of early esophageal cancers in patients who underwent an esophagectomy to evaluate the accuracy of staging by endoscopic ultrasound and how this affects treatment recommendations. METHODS A prospective esophagectomy database of all patients undergoing an esophagectomy for esophageal cancer at a single high-volume institution was retrospectively reviewed for patients with early-stage esophageal cancer. This study analyzed patients with clinical Tis to T1 disease, as predicted by preoperative endoscopic ultrasound, and correlated this with the pathologic stages after esophagectomy. The surgical outcomes were evaluated to assess the safety of esophagectomy as a treatment modality. RESULTS From 2005 to 2011, 107 patients (93 male, 14 female) with a mean age of 66 years (range, 39-91 years) were staged by preoperative endoscopic ultrasound to have esophageal high-grade dysplasia, carcinoma in situ, or T1 cancer and underwent an esophagectomy. Tumor depth was correctly staged by endoscopic ultrasound in only 39% (23/59) of pT1a tumors (invading into the lamina propria or muscularis mucosa) and 51% (18/35) of pT1b tumors (submucosal). Of the endoscopic ultrasound-staged cT1a-lpN0 lesions, there were positive lymph nodes in 15% of pathologic specimens (2/13). Patients with pT1a-mm lesions had a 9% rate of pathologic lymph node involvement (1/11), and those with pT1b tumors had a 17% rate of lymph node spread (6/35). Esophagectomy was performed in all 107 patients with a 30-day mortality rate of less than 1% (1/107). CONCLUSIONS The sensitivity and specificity of endoscopic ultrasound for determining true pathologic staging are poor for early-stage esophageal cancers. Lesions thought to be cT1a-lpN0 by endoscopic ultrasound have at least pN1 disease in 15% of cases. Endoluminal therapy of these lesions based on endoscopic ultrasound undertreats a significant number of patients. Esophagectomy is still the standard therapy for early-stage esophageal cancers in the majority of patients.
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Affiliation(s)
- Edward J Bergeron
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Andrew C Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Mark B Orringer
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich.
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11
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Appelman HD, Streutker C, Vieth M, Neumann H, Neurath MF, Upton MP, Sagaert X, Wang HH, El-Zimaity H, Abraham SC, Bellizzi AM. The esophageal mucosa and submucosa: immunohistology in GERD and Barrett's esophagus. Ann N Y Acad Sci 2013; 1300:144-165. [DOI: 10.1111/nyas.12241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Michael Vieth
- Department of Medicine; University of Erlangen-Nuremberg; Erlangen Germany
| | - Helmut Neumann
- Department of Medicine; University of Erlangen-Nuremberg; Erlangen Germany
| | - Markus F. Neurath
- Department of Medicine; University of Erlangen-Nuremberg; Erlangen Germany
| | - Melissa P. Upton
- Department of Pathology; University of Washington, Seattle; Washington
| | - Xavier Sagaert
- Department of Pathology; Department of Imaging & Pathology; KU Leuven; Leuven Belgium
| | - Helen H. Wang
- Department of Pathology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston Massachusetts
| | | | - Susan C. Abraham
- Department of Pathology; University of Texas M. D. Anderson Cancer Center; Houston Texas
| | - Andrew M. Bellizzi
- Department of Pathology; University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
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12
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Duplicated muscularis mucosae invasion has similar risk of lymph node metastasis and recurrence-free survival as intramucosal esophageal adenocarcinoma. Am J Surg Pathol 2011; 35:1045-53. [PMID: 21602659 DOI: 10.1097/pas.0b013e318219ccef] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Duplicated muscularis mucosae (MM) in early esophageal adenocarcinoma (EAC) can cause overstaging of the disease on endoscopic ultrasound and pathology specimens. No study has determined the correlation between lymph node metastasis and invasion in the space between duplicated MM in pathologic tumor stage (pT) 1 EAC. Hematoxylin and eosin-stained slides from surgically resected pT1 EAC (n=99) were reviewed for tumor configuration, grade, level of invasion (lamina propria/inner MM, space between duplicated MM, and submucosa), quantitative depth of invasion in millimeter, and lymphovascular invasion (LVI). These pathologic characteristics were correlated with lymph node status and recurrence-free survival (RFS). All specimens had duplicated MM with thick-walled blood vessels. Tumor differentiation was well in 37, moderate in 47, and poor in 15 specimens. EAC invaded the lamina propria/inner MM in 28 cases, duplicated MM space in 41 cases, and submucosa in 30 cases. LVI was identified in 23 tumors. Eleven patients had lymph node metastasis. Quantitative depth of invasion as a continuous variable (P=0.002), poorly differentiated histology (P=0.028), presence of LVI (P=0.001), and submucosal invasion versus duplicated MM/lamina propria invasion (P=0.02) were associated with increased risk of lymph node metastasis and shorter RFS by univariate analysis. By multivariate analysis, LVI was an independent predictor of lymph node status and RFS. EAC invasion into the space between duplicated MM confers a similar risk of lymph node metastasis and recurrence as those of intramucosal EAC, and LVI is the best predictor of lymph node status and RFS in pT1 EAC.
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13
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Patil DT, Plesec TP, Goldblum JR. Low prevalence of invasive adenocarcinoma and occult cancer on esophageal resection for Barrett's esophagus with high-grade dysplasia: Evidence for conservative management. J Gastrointest Oncol 2011; 2:5-7. [PMID: 22811819 DOI: 10.3978/j.issn.2078-6891.2011.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 02/05/2011] [Indexed: 11/14/2022] Open
Affiliation(s)
- Deepa T Patil
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
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14
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Montani M, Thiesler T, Kristiansen G. Smoothelin is a specific and robust marker for distinction of muscularis propria and muscularis mucosae in the gastrointestinal tract. Histopathology 2010; 57:244-9. [PMID: 20716166 DOI: 10.1111/j.1365-2559.2010.03618.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS As tumour specimens and biopsy specimens become smaller, recognition of anatomical structures relevant for staging is increasingly challenging. So far no marker is known that reliably discriminates between muscularis propria (MP) and muscularis mucosae (MM) of the gastrointestinal tract. Recently, smoothelin expression has been shown to differ in MP and MM of the urinary bladder. We aimed to analyse the expression of smoothelin in the gastrointestinal tract in MP and MM in order to define a novel diagnostic tool to identify MM bundles. METHODS AND RESULTS The expression of smoothelin was analysed immunohistochemically in comparison with alpha-smooth muscle actin (alpha-SMA) in specimens from colon, stomach and oesophagus (n = 107). In contrast to alpha-SMA, which equally stained MM and MP, absent or significantly weaker smoothelin expression was found in MM was found, which was particularly valid in colon and gastric specimens. CONCLUSIONS The combination of smoothelin and SMA represents a robust marker to discriminate MM from MP in the gastrointestinal tract.
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Affiliation(s)
- Matteo Montani
- Institut für Klinische Pathologie, UniversitätsSpital Zürich, Schmelzbergstrasse 12, Zürich, Switzerland.
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15
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Young PE, Gentry AB, Acosta RD, Greenwald BD, Riddle M. Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus. Clin Gastroenterol Hepatol 2010; 8:1037-41. [PMID: 20831900 DOI: 10.1016/j.cgh.2010.08.020] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Patients with esophageal high-grade dysplasia or mucosal esophageal cancer can be successfully treated by endoscopy. We performed a systematic review of the literature to determine whether endoscopic ultrasound (EUS) correctly predicts the T-stage of early esophageal cancers, compared with pathology specimens obtained by using endoscopic mucosal resection (EMR) or surgery. METHODS Standard systematic review methods were used to perform reference searches, determine eligibility, abstract data, and analyze data. When possible, individual patient-level data were abstracted, in addition to publication-level aggregate data. RESULTS Twelve studies had sufficient information to abstract and review for quality; 8 had individual patient-level data (n = 132). Compared with surgical or EMR pathology staging, EUS had T-stage concordance of 65%, including all studies (n = 12), but only 56% concordance when limited to individual patient-level data. Factors such as initial biopsy pathology (high-grade dysplasia vs early-stage cancer) did not appear to affect the concordance of staging between EUS and EMR/surgical staging. CONCLUSIONS EUS is not sufficiently accurate in determining the T-stage of high-grade dysplasias or superficial adenocarcinomas; other means of staging, such as EMR, should be used.
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Affiliation(s)
- Patrick E Young
- National Naval Medical Center, Bethesda, Maryland 20889, USA.
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Lauwers GY, Badizadegan K. New Endoscopic Techniques: Challenges and Opportunities for Surgical Pathologists. Surg Pathol Clin 2010; 3:411-28. [PMID: 26839138 DOI: 10.1016/j.path.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, significant clinical and technological advances have been made in endoscopic methods for diagnosis and treatment of early gastrointestinal neoplasms. However, essential information related to these novel techniques and their implications for practicing surgical pathologists have largely been missing in the general pathology literature. This article provides a general introduction to these novel therapeutic and diagnostic methods, and discusses their indications, contraindications, and potential limitations. The article aims to enable surgical pathologists to interact more efficiently with basic scientists and clinical colleagues to help implement and improve the existing clinical methods and to advance the new technologies.
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Affiliation(s)
- Gregory Y Lauwers
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Kamran Badizadegan
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
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Barbour AP, Jones M, Brown I, Gotley DC, Martin I, Thomas J, Clouston A, Smithers BM. Risk stratification for early esophageal adenocarcinoma: analysis of lymphatic spread and prognostic factors. Ann Surg Oncol 2010; 17:2494-502. [PMID: 20349213 DOI: 10.1245/s10434-010-1025-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knowledge of factors related to outcome is vital for the selection of therapeutic alternatives for patients with early (T1) esophageal adenocarcinoma. This study was undertaken to determine predictors of lymphatic spread and prognostic factors for T1 esophageal adenocarcinoma following esophagectomy. MATERIALS AND METHODS A prospectively maintained database identified 85 patients with T1 esophageal adenocarcinoma who underwent esophagectomy without neoadjuvant therapy. Depth of tumor invasion (T stage) was subdivided into mucosal (T1a) or submucosal invasion (T1b). Median follow-up was 59 months. RESULTS Thoracoscopically assisted 3-phase esophagectomy was performed in 73 of 85 patients (86%). Lymph node metastases (N stage) were identified in 9 of 85 patients (11%). Depth of tumor invasion (T stage), lymphovascular invasion (LVI), and poor differentiation were associated with N stage. The patients could be stratified into 4 risk groups for lymph node metastases: group I--T1a (0 of 35 patients [0%] with positive nodes); group II--T1b, well/moderate differentiation and no LVI (1 of 28 patients [4%] with positive nodes); group III--T1b, poor differentiation and no LVI (2 of 9 patients [22%] with positive nodes); and group IV--T1b any grade with LVI (6 of 13 patients [46%] with positive nodes). Survival analyses found T stage, N stage, LVI, and poor differentiation to be significant prognostic factors. CONCLUSIONS Risk stratification is possible for patents with T1 esophageal adenocarcinoma. Local resection techniques without lymphadenectomy may be alternatives for T1a tumors. Esophagectomy should remain the standard of care for patients with T1b tumors and those with LVI or poor differentiation considered for neoadjuvant therapy.
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Affiliation(s)
- Andrew P Barbour
- Division of Surgery, University of Queensland, Brisbane, QLD, Australia.
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