Immunohistochemistry (IHC) Tests Panel on Esophageal Biopsies in Patients with Barrettʼs Esophagus: Does it Really Help?

Abstract

Purpose: We have increasingly noted the use of immunohistochemistry testing (IHC) performed by outside pathology laboratories in patients subsequently referred for endoscopic therapy of Barrett's disease. While histology results are considered the gold standard in the diagnosis of esophageal dysplasia or adenocarcinoma (EAC), some centers now perform IHC testing regardless of histology findings. IHC panels purportedly confirm the presence of Barrett's esophagus (BE) and its malignant potential. IHC panels are reported as a composite of markers, such as MOC 31, BER-EP-4, AK1/AE3, CK 5/6/45/138/903, Villin, CDX2, and P16/21/53. The aim of our study is to correlate IHC results with esophageal biopsy histologic findings. Methods: We reviewed our prospectively collected BE treatment database for patients who underwent EMR (endomucosal resection) or ablation therapy using RFA (radiofrequency ablation) for BE lesions from 2002-2011. As IHC testing is not performed at our institution, we searched outside records of referred patients who had IHC tests performed elsewhere. Patients' demographics, outside esophageal biopsy pathology results, IHC results and our EMR or mucosal biopsy histology results were recorded. Results: We reviewed 456 patients' charts that underwent EMR or RFA for BE. Among them, we found 8 patients (50% Male) with BE who received IHC testing. Their mean age was 54.8 (range 35-71) years and mean BMI was 29.9 (range 27.6-35.4) kg/m2. EMR for nodular or dysplastic BE was performed in 3 patients while 5 had RFA. The agreement of histologic findings and IHC results was found in 4 patients with non-dysplastic BE. In the other 3 patients, while IHC testing found no Barrett's dysplasia, the mucosal biopsies found BE-HGD (high grade dysplasia) and subsequent EMR procedures found intramucosal and submucosal adenocarcinoma (1 each). In each of these 8 patients, IHC tests were performed on approximately 1-9 esophageal biopsy specimens adding cost of $108-$972 ($108 per biopsy specimen). Conclusion: In this small group of BE patients referred for endoscopic therapy, the results of IHC tests did not reliably detect BE dysplasia or cancer, compared with histologic analysis of mucosal biopsy or endoscopic resection specimens. The use of IHC tests added expense and provided unreliable BE disease stage information in our patients with esophageal cancer.