[762] Histopathological Analysis of Glandular Lesions in Esophageal Endoscopic Mucosal Resections (EMR) with Emphasis in Follow-Up Tissue Findings

S Yasir, MT Garcia, PA Bejarano. University of Miami/Jackson Memorial Hospital, Miami, FL

Background: EMR is used in the management of Barrett's esophagus-related superficial neoplasms.The aim of this study is to evaluate features in EMR and correlate their margin status with the findings on follow-up (FU) biopsies.
Design: Slides of 50 EMR specimens from 45 patients (39 men and 6 women; mean age 68 y) and their available FU tissues were reviewed.
Results: The mean number of fragments was 2.7. All cases had squamo-columnar mucosa. The mean size of the largest fragment was 0.81cm. The deepest structure in the fragments was superficial muscularis mucosae, deep muscularis mucosae and submucosa in 1, 10 and 39 cases respectively. The most severe abnormality included low grade dysplasia (LGD=10%), high grade dysplasia (HGD=26%), intramucosal carcinoma (IMC=28%) and invasive carcinoma (ICA=10%). In 26% of cases, there was no dysplasia or carcinoma. Intestinal metaplasia (IM) present in 84% (n=42) of resections was associated with LGD (10%), HGD (26%), IMC (24%) and ICA (8%) (p 0.02). In 10% of cases, IM was not associated with dysplasia or malignancy. In 16% (n=8) of resections, IM was not present. However, 4% and 2% of these showed IMC and ICA respectively. FU biopsy tissue diagnosis was obtained in 33 patients at an average of 19.5 weeks. Only one (3%) of the 33 patients had more severe disease on FU (LGD to HGD). In the other 32 patients, 2 (6%) continued with same lesion type, 9 (27%) showed a less severe lesion and 21 (64%) were negative (p 0.2). Fifteen (45%) patients had negative margins at initial EMR. Of those, 3 (9%) showed recurrent disease on FU (2 LGD, I HGD). In the remaining 18 patients with positive margins at initial EMR, 7 (21%) showed the same lesion type, 2 (6%) a less severe lesion, 9 (27%) became negative and none had more severe disease on FU (p 0.3).

Table 1. Comparison of Initial and Follow-up Diagnosis
Initial diagnosis at EMRFollow-up Diagnosis
NegativeLGDHGDIMCICA
Negative (4)40000
LGD (4)21100
HGD (10)54100
IMC (10)61300
ICA (5)40010



Conclusions: The large majority of patients will have histological improvement on FU biopsies. Despite negative margins in EMRs, recurrence of disease may be seen in a minority of patients. On follow up, EMRs with initial positive margins are mostly associated with persistent, less severe or no lesion but not with disease progression. However, longer FU in a larger sample will be needed to confirmation.
Category: Gastrointestinal

Wednesday, March 24, 2010 9:30 AM

Poster Session V # 75, Wednesday Morning

 

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