Study of Preoperative and Postoperative Pathology in High Grade Barrett's Dysplasia

Abstract

Introduction: High grade dysplasia in the setting of Barrett's disease is often managed with surgical resection, because of the risk of concomitant adenocarcinoma. However, improvements in endoscopic diagnosis may have reduced the risk of undetected cancer. We investigated the association of adenocarcinoma with high grade dysplasia at surgical resection in relation to date of procedure. Methods: Using the electronic medical record, we identified patients who underwent esophagectomy for high grade dysplasia, at the University of Pittsburgh Medical Center, between 1993 and 2007. Preoperative diagnosis was confirmed by reviewing pathology reports and postoperative pathology reports were reviewed and compared to the preoperative diagnosis. Results: 68 patients (12 females and 56 males) with a preoperative diagnosis of high grade dysplasia were evaluated. The mean age was 64 years (range 36 to 86 years). 12 of 68 (17.6 %) had adenocarcinoma, 2 were downgraded to low grade dysplasia and 54 were confirmed as HGD. Subgroup analysis was performed based on the date of operation. When analyzed by date of operation, 3/20 (15%) had adenocarcinoma between 1993 - 2000 versus 9/48 (18.8%) between 2001 - 2007 (p = 0.770). Among the most recent cases, 8/40 (20%) had adenocarcinoma from 1993 - 2003, versus 4/28 (14%) between 2004 - 2007 (p = 0.379). Conclusion: The rate of adenocarcinoma in association with HGD and Barrett's in this series was 18%, and remained at a similar rate, even in the last few years of clinical practice. Advanced endoscopic techniques to identify adenocarcinoma in the setting of HGD/Barrett's remain a clinical priority.