Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

Abstract Background Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). The western pathologists’ experience with ESD specimens remains limited. This study aimed to correlate histopathologic features of Barrett’s esophagus (BE)-associated...

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Autores principales:	Sadhna Dhingra, Firas Bahdi, Sarah B. May, Mohamed O. Othman
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Barrett’s esophagus Mucosal adenocarcinoma Submucosal adenocarcinoma Endoscopic submucosal dissection Tumor budding Pathology RB1-214
Acceso en línea:	https://doaj.org/article/189bec05174f47f5bd1e2171153429ca
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spelling	oai:doaj.org-article:189bec05174f47f5bd1e2171153429ca2021-11-28T12:37:12ZClinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens10.1186/s13000-021-01169-11746-1596https://doaj.org/article/189bec05174f47f5bd1e2171153429ca2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13000-021-01169-1https://doaj.org/toc/1746-1596Abstract Background Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). The western pathologists’ experience with ESD specimens remains limited. This study aimed to correlate histopathologic features of Barrett’s esophagus (BE)-associated adenocarcinoma in ESD resections with clinical outcomes to determine whether they aid future management decisions. Methods We retrospectively evaluated 49 consecutive ESD resection specimens from 42 patients with BE-associated adenocarcinoma (24 intramucosal and 18 submucosal EAC) at a single tertiary referral center. Pathologic evaluation included presence of dysplasia, invasive adenocarcinoma, peritumoral inflammation, desmoplasia, lymphovascular and perineural invasion; tumor differentiation, depth of invasion, morphology, and budding; and margin status for dysplasia or carcinoma. Follow up data included endoscopic biopsies in 35 patients and pathology reports of esophagectomies in 11 patients. Poor outcomes were defined as recurrence or residual invasive adenocarcinoma at esophagectomy, metastasis on imaging, or R1 resection in patients undergoing ESD for tumor debulking. Results Two patients (8%) with intramucosal adenocarcinoma and 9 patients (50%) with submucosal adenocarcinoma had poor outcomes. Histopathologic features associated with poor outcomes included poor differentiation, lymphovascular invasion, submucosal invasion > 500 μm, tumor budding, and tubuloinfiltrative histologic pattern. Four patients had positive deep margin away from the deepest tumor invasion and did not show residual tumor on follow up. Conclusions Our results validated European Society of Gastroenterology (ESGE) guidelines of high-risk pathologic features for additional therapy in esophageal adenocarcinoma and identified tumor budding frequently in association with other high-risk features. Positive deep margin distant from deepest tumor invasion could be procedural and warrants endoscopic correlation for management.Sadhna DhingraFiras BahdiSarah B. MayMohamed O. OthmanBMCarticleBarrett’s esophagusMucosal adenocarcinomaSubmucosal adenocarcinomaEndoscopic submucosal dissectionTumor buddingPathologyRB1-214ENDiagnostic Pathology, Vol 16, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Barrett’s esophagus Mucosal adenocarcinoma Submucosal adenocarcinoma Endoscopic submucosal dissection Tumor budding Pathology RB1-214
spellingShingle	Barrett’s esophagus Mucosal adenocarcinoma Submucosal adenocarcinoma Endoscopic submucosal dissection Tumor budding Pathology RB1-214 Sadhna Dhingra Firas Bahdi Sarah B. May Mohamed O. Othman Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
description	Abstract Background Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). The western pathologists’ experience with ESD specimens remains limited. This study aimed to correlate histopathologic features of Barrett’s esophagus (BE)-associated adenocarcinoma in ESD resections with clinical outcomes to determine whether they aid future management decisions. Methods We retrospectively evaluated 49 consecutive ESD resection specimens from 42 patients with BE-associated adenocarcinoma (24 intramucosal and 18 submucosal EAC) at a single tertiary referral center. Pathologic evaluation included presence of dysplasia, invasive adenocarcinoma, peritumoral inflammation, desmoplasia, lymphovascular and perineural invasion; tumor differentiation, depth of invasion, morphology, and budding; and margin status for dysplasia or carcinoma. Follow up data included endoscopic biopsies in 35 patients and pathology reports of esophagectomies in 11 patients. Poor outcomes were defined as recurrence or residual invasive adenocarcinoma at esophagectomy, metastasis on imaging, or R1 resection in patients undergoing ESD for tumor debulking. Results Two patients (8%) with intramucosal adenocarcinoma and 9 patients (50%) with submucosal adenocarcinoma had poor outcomes. Histopathologic features associated with poor outcomes included poor differentiation, lymphovascular invasion, submucosal invasion > 500 μm, tumor budding, and tubuloinfiltrative histologic pattern. Four patients had positive deep margin away from the deepest tumor invasion and did not show residual tumor on follow up. Conclusions Our results validated European Society of Gastroenterology (ESGE) guidelines of high-risk pathologic features for additional therapy in esophageal adenocarcinoma and identified tumor budding frequently in association with other high-risk features. Positive deep margin distant from deepest tumor invasion could be procedural and warrants endoscopic correlation for management.
format	article
author	Sadhna Dhingra Firas Bahdi Sarah B. May Mohamed O. Othman
author_facet	Sadhna Dhingra Firas Bahdi Sarah B. May Mohamed O. Othman
author_sort	Sadhna Dhingra
title	Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
title_short	Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
title_full	Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
title_fullStr	Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
title_full_unstemmed	Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
title_sort	clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
publisher	BMC
publishDate	2021
url	https://doaj.org/article/189bec05174f47f5bd1e2171153429ca
work_keys_str_mv	AT sadhnadhingra clinicopathologiccorrelationsofsuperficialesophagealadenocarcinomainendoscopicsubmucosaldissectionspecimens AT firasbahdi clinicopathologiccorrelationsofsuperficialesophagealadenocarcinomainendoscopicsubmucosaldissectionspecimens AT sarahbmay clinicopathologiccorrelationsofsuperficialesophagealadenocarcinomainendoscopicsubmucosaldissectionspecimens AT mohamedoothman clinicopathologiccorrelationsofsuperficialesophagealadenocarcinomainendoscopicsubmucosaldissectionspecimens
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Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

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