Biopsy is inadequate for precise diagnosis of neoplasia in patients with Barrett's esophagus

Czech version

Authors: M. Stefanová ¹; I. Tučková ²; J. Malušková ³; M. Kollár ³; J. Špičák ⁴; J. Martínek ⁴
Authors‘ workplace: Interní oddělení, Nemocnice Na Františku, Praha ¹; Oddělení patologie, ÚVN, Praha ²; Patologické oddělení, IKEM, Praha ³; Klinika hepatogastroenterologie, IKEM, Praha ⁴
Published in: Gastroent Hepatol 2013; 67(4): 264-270
Category: Clinical and Experimental Gastroenterology: Original Article

Overview

Endoscopic resection (ER) is a diagnostic and therapeutic method of treatment of early esophageal neoplasia. Diagnosis of neoplasia is usually based on forceps biopsy. However, it is not clear whether the diagnostic agreement between forceps biopsies and ER is sufficient.

Aim:
To compare diagnostic yield of targeted biopsies compared with ER in patients with early esophageal neoplasia, and to analyze histological diagnosis and the advancement of lesions based on the macroscopic type.

Method:
69 patients with 78 suspected lesions of the esophagus (eight women and 61 men, average age 63 years, range 34–85) undergoing both targeted biopsies with trimodal endoscopy, and ER.

Results:
Initial diagnoses of targeted biopsies were: 17× early adenocarcinoma (EAC), two squamous carcinoma (SCC), 36× high-grade dysplasia (HGD), and 23× low-grade dysplasia (LGD). Compared to prior forceps biopsies, histopathology from ER specimen was the same in 45 lesions (58%) and changed in 33 lesions (42%). In 21 samples (63%) diagnosis has been up-staged after ER. In 12 samples (37%) diagnosis has been down-staged. Macroscopic lesion type 0-IIa (slightly protruding lesion) and 0-IIb (flat lesion) were the most frequent in our study. From a total of 39 cancers (diagnosis based on ER), 20 (51%) were in lesion type 0-IIa.

Conclusion:
Targeted biopsies are not sufficient for an accurate diagnosis of esophageal cancer. ER should be preferred as a diagnostic method in patients with suspected esophageal neoplasia.

Key words:
Barrett’s esophagus – neoplasia – targeted biopsy – endoscopic resection

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
19. 7. 2013

Accepted:
9. 8. 2013

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