Abstract
BackgroundEndoscopic 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.MethodsWe 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.ResultsTwo 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.ConclusionsOur 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.
Highlights
Recent advances in endoscopic resection have led to a paradigm shift in the management of Barrett’s esophagus (BE)–related superficial adenocarcinoma from major surgical resection, with its high morbidity, to organ-sparing, minimally invasive endoscopic approaches
The European Society of Gastrointestinal Endoscopy (ESGE) published guidelines regarding the role of endoscopic submucosal dissection (ESD) in BE-associated adenocarcinoma and provided recommendations for additional therapeutic management based on histologic findings of ESD resection specimens, which predict the risk of lymph node metastasis [4]
The aim of this study is to evaluate the histopathologic features of BE-associated adenocarcinoma in ESD resections and correlate these features with clinical outcomes and pathology from follow-up esophagectomy to examine the robustness of ESGE recommendations for additional therapy
Summary
Recent advances in endoscopic resection have led to a paradigm shift in the management of Barrett’s esophagus (BE)–related superficial adenocarcinoma from major surgical resection (esophagectomy), with its high morbidity, to organ-sparing, minimally invasive endoscopic approaches. Histologic assessment of endoscopic resection specimens provides information for risk stratification, which determines further management with surveillance endoscopy or additional therapies, such as endoscopic ablative therapies or endoscopic resections, radical esophagectomy, or chemoradiation. The European Society of Gastrointestinal Endoscopy (ESGE) published guidelines regarding the role of ESD in BE-associated adenocarcinoma and provided recommendations for additional therapeutic management based on histologic findings of ESD resection specimens, which predict the risk of lymph node metastasis [4]. Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). 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
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