Foveolar and Serrated Dysplasia Are Rare High-Risk Lesions in Barrett's Esophagus: A Prospective Outcome Analysis of 214 Patients
A Srivastava, CA Sanchez, DS Cowan, RD Odze. Dartmouth Hitchcock Medical Center, Lebanon; Fred Hutchinson Cancer Center & University of Washington, Seattle; Brigham & Women's Hospital, Boston
Background: Most dysplasia in BE is adenomatous, composed of cells with stratified, pencil shaped hyperchromatic nuclei. Rarely, dysplasia shows cytoplasmic features similar to gastric "foveolar" dysplasia, or serration combined with cytoplasmic eosinophilia reminiscent of serrated adenomas of the colon. The clinical and molecular characteristics, and risk of cancer, of these subtypes of dysplasia are unknown. The aim of this study was to evaluate the prevalence rate and outcome of BE patients with foveolar (FD) or serrated (SD) dysplasia from a large prospective cohort of high-risk BE patients.
Design: 3999 mucosal biopsies from 214 BE patients [mean age:62.9 yrs, M/F ratio: 170:44, mean BE segment length 5.69 cm], were evaluated for the type (conventional, FD, SD) and grade of conventional dysplasia. Patients with FD or SD were compared to patients with conventional LGD or HGD for a variety of clinical features and for outcome. Goblet cell density (GCD=mean # goblet cells/crypt) in adjacent non-dysplastic epithelium, and flow cytometric abnormalities (aneuploidy or increased 4N fraction) were evaluated in all cases.
Results: Overall, 150 patients (70%) were negative for dysplasia, 22 (10%) had conventional LGD, 16 (7.5%) conventional HGD, 17 (7.9%) had FD and 6 (2.8%) had SD. Three patients (1.4%) had foci of both FD and SD in the same biopsies. The GCD in patients with FD (1.78) was significantly lower than patients with conventional LGD (6.95; p<0.0001) or HGD (4.2; p=0.006). Flow abnormalities were present in 13/17 (76.5%) FD cases which was significantly higher than conventional LGD (5/22; p=0.0013), but similar to HGD (9/16; P=0.28). 8/17 (47.0%) FD patients progressed to cancer, which was also significantly higher than LGD (1/22; p=0.005), but similar to HGD (12/16; p=0.16). Progression to cancer was also high in SD (3/6; 50%) compared to LGD (p=0.02), but similar to HGD (p=0.33). GCD and flow abnormalities in SD were not significantly different from conventional LGD and HGD.
Conclusions: Our findings suggest that FD and SD are rare morphological variants of dysplasia in BE that reveal flow abnormalities and a high potential for adenocarcinoma. Based on these data, these rare subtypes may be considered high grade but further studies with larger number of patients with long term follow up are needed to validate these findings.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 66, Wednesday Morning