Abstract
BackgroundThe prevalence of Barrett’s esophageal adenocarcinoma (BEA) is increasing in Japan. Accurate assessment of lymphovascular invasion (LVI) after endoscopic resection or surgery is essential in evaluating treatment response. This study aimed to assess the usefulness of immunostaining in determining the extent of LVI in superficial BEA.MethodsWe retrospectively included 41 patients who underwent endoscopic resection or surgery between January 2007 and July 2018. In all cases, 3-μm serial sections from paraffin-embedded resected specimens were used for hematoxylin and eosin (H-E) staining and immunostaining for D2–40 and CD31. Two specialized gastrointestinal pathologists (T.Y. and T.T.), blinded to clinical information, independently evaluated the extent of LVI from these specimens. The LVI-positivity rate was evaluated with respect to the depth of invasion, changes in the positivity rate on immunostaining, pathological characteristics of patients with LVI, lymph node metastasis or relapse, and course after treatment.ResultsH-E staining alone identified LVI in 7 patients (positivity rate: 17.1%). Depths of invasion were categorized based on extension to the submucosa (SM) or deeper. On immunostaining for D2–40 and CD31, additional positivity was detected in 2 patients with SM1 and 1 SM3, respectively; LVI was detected in 10 patients (positivity rate: 24.4%). LVI-positivity rates with invasion of the superficial muscularis mucosa (SMM)/lamina propria mucosa (LPM)/deep muscularis mucosa (DMM), SM 1, 2, and 3 were 0, 75, 28.6, and 55.6%, respectively.ConclusionsCombined H-E staining and immunostaining is useful in diagnosing LVI in superficial BEA, particularly in endoscopically resected specimens.
Highlights
The prevalence of Barrett’s esophageal adenocarcinoma (BEA) is increasing in Japan
In Barrett’s esophagus (BE), columnar epithelium replaces normal squamous epithelium in the distal esophagus owing to repeated esophageal inflammation, injury, and repair caused by regurgitation of gastric acid or bile [1, 2]
Adenocarcinoma originating from BE is termed Barrett’s esophageal adenocarcinoma (BEA)
Summary
The prevalence of Barrett’s esophageal adenocarcinoma (BEA) is increasing in Japan. Adenocarcinoma originating from BE is termed Barrett’s esophageal adenocarcinoma (BEA). The incidence of gastroesophageal reflux disease (GERD) has recently increased in Japan owing to the introduction of a Western-style diet and a decrease in the incidence of Helicobacter pylori infection [7]. This change may increase the incidence of BE, and BEA. Several studies have reported a slight increase in the incidence of BEA in Japan [8, 9]. The 5-year survival rate for advanced BEA without distant metastases is only < 20% [10]; early diagnosis and treatment are essential
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