Prediction of Adenocarcinoma (ADC) on Esophagectomy from Pre-Resection Biopsies of Barrett's Esophagus (BE) with at Least High Grade Dysplasia (HGD): A Comparison of Two Systems
DT Patil, JR Goldblum, T Plesec, A Bennett, W Henricks, L Schoenfield, L Yerian, MP Bronner, L Rybicki, T Rice, E Downs-Kelly. Cleveland Clinic, Cleveland
Background: Distinguishing BE-HGD from intramucosal carcinoma (IMC) and submucosal carcinoma (SMC) on biopsies is important due to different therapeutic options, some of which are reserved for "cancer". In regards to pre-resection biopsies, Downs-Kelly et al [Am J Gastroenterol 2008 (CC)]outlined 4 diagnostic categories: HGD, HGD with marked glandular architectural distortion, cannot exclude IMC (HGD/MAD), IMC and SMC while Zhu et al [Am J Clin Path 2009 (UM)] described criteria for HGD “suspicious” for ADC (HGD/S). This study evaluates pre-resection biopsies from patients who underwent esophagectomy for BE with at least HGD to:1) compare CC and UM systems, 2) correlate pre and final resection diagnosis, and 3) identify histologic features in biopsies that might be predictive of ADC on esophagectomy.
Design: Using the CC system, 7 GI pathologists reviewed 168 pre-resection biopsies with at least HGD; those biopsies with a consensus diagnosis (agreement by ≥4 pathologists) were included. Logistic regression analysis was used to identify endoscopic and histologic features that predicted ADC on esophagectomy.
Results: Of the112 pre-resection biopsies with a consensus diagnosis, 83 (74%) had ADC on esophagectomy (59 IMC, 24 SMC). Pre-resection diagnoses were: 32 HGD (29%), 32 HGD/MAD (29%), 45 IMC (40%) and 3 SMC (2%). Applying UM system to the biopsy series showed excellent overall agreement with CC system (k=0.86). Both systems showed significant correlation between preop and esophagectomy diagnosis (p<0.001). The likelihood of finding ADC on resection was significantly higher with HGD/MAD (OR 2.9, p=0.04) or HGD/S (OR 5, p=0.002), compared to HGD. Presence of an endoscopic lesion (OR 4.7, p=0.002), "never-ending" gland pattern (OR 3.7, p=0.016), sheet-like growth (chi2 p<0.001), angulated glands (OR 8.5, p=0.001), ≥3 dilated glands with intraluminal debris (OR 2.6, p=0.045), and >1 focus of single cell infiltration into lamina propria (OR 8.9, p<0.001) increased the odds of finding ADC on resection. The latter two variables remained independent predictors of ADC in multivariable analysis.
Conclusions: The CC and UM systems had excellent agreement and both were predictive of resection diagnosis. The finding of ≥3 dilated glands with intraluminal debris and >1 focus of single cell infiltration into the lamina propria were independent histologic predictors of ADC on resection.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 64, Wednesday Morning