Histologic Features Predicting High Risk of Submucosal Invasion in Mucosal Biopsies of Esophageal Adenocarcinoma
Baojin Fu, Tyler Foxwell, Huankai Hu, Alyssa M Krasinskas, Katie S Nason, Jon M Davison. University of Pittsburgh School of Medicine, Pittsburgh, PA
Background: Esophageal adenocarcinoma (EAC) is diagnosed at an early, superficial stage with increasing frequency. In some cases, treatment options depend entirely on the extent of local invasion. Pathologists are often challenged to make the distinction in mucosal biopsies between early, intramucosal and more locally advanced EAC, which can be difficult in the absence of endoscopic ultrasound and other clinical correlates. We designed a case control study to evaluate the odds of submucosal invasion associated with different morphologic patterns seen in mucosal biopsies of EAC.
Design: We identified pre-operative endoscopic mucosal biopsies from 43 patients with adenocarcinoma of the distal esophagus or GE junction demonstrating at least submucosal invasion (stage T1b-T4). For controls, we identified biopsies from 29 patients with high grade dysplasia or intramucosal adenocarcinoma (stage Tis-T1a). All patients were treated by esophagectomy without induction therapy between 1996 and 2010. Blinded to the final pathologic stage, we evaluated the pre-operative biopsies for the presence of multiple morphologic patterns believed to correlate with early mucosal invasion (e.g. foci of single cell invasion) as well as patterns that may be indicative of more advanced local invasion (e.g. desmoplasia).
Results: Results are summarized in Table 1.
Several morphologic features (Group A) were significantly more common in T1b-T4 EAC. The greatest odds of submucosal invasion was associated with ulcerated adenocarcinoma. Desmoplasia was one of several rare features (Group B) seen almost exclusively in T1b-T4 EAC. A final group of morphologic characteristics (Group C) was present with nearly equal frequency in Tis-T1a and T1b-T4 EAC.
Conclusions: Unequivocal desmoplasia was rarely identified in mucosal biopsies of locally advanced (T1b-T4) EAC. Multiple histologic features in addition to desmoplasia can be used to assess the risk of submucosal or deeper local invasion in EAC in pre-operative mucosal biopsies.
Monday, March 4, 2013 1:00 PM
Poster Session II # 117, Monday Afternoon