title: Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett's esophagus.
abstract: OBJECTIVE
  Although EMR has been used for elimination of neoplasia in BE, the significance of positive carcinoma margins and depth of invasion on endoscopic resection pathology has not been assessed using a valid standard. The aim of this study was to assess the accuracy of tumor staging by EMR using esophagectomy as the standard.
  
  
  METHODS
  Medical records of patients, who underwent endoscopic resection for esophageal carcinoma or high-grade dysplasia in BE followed by esophagectomy, were reviewed. Data were abstracted from a prospectively maintained EMR database. Endosonography and endoscopic resection were performed by a single experienced endoscopist. Two experienced GI pathologists interpreted all histological results. Standard statistical tests were used to compare continuous and categorical variables.
  
  
  RESULTS
  Twenty-five patients were included in the study. Three patients had mucosal carcinoma and 16 had submucosal carcinoma following endoscopic resection. Surgical pathology staging was consistent with preoperative EMR staging in all patients. No patient with negative mucosal resection margins had residual tumor at the resection site at esophagectomy. In patients with submucosal carcinoma, 8 had residual carcinoma at the EMR site at surgery and 5 patients had metastatic lymphadenopathy.
  
  
  CONCLUSIONS
  Tumor staging using EMR pathology is accurate when compared with surgical pathology following esophagectomy. Negative margins on EMR pathology correlate with absence of residual disease at the EMR site at esophagectomy. Submucosal carcinoma on EMR specimens was associated with a high prevalence of residual disease at surgery (50%) and metastatic lymphadenopathy (31%).
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Ganapathy A
authors.initials: GA
authors.lastname: Prasad
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Buttar
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wongkeesong
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lewis
authors.forename: Schuyler O
authors.initials: SO
authors.lastname: Sanderson
authors.forename: Lori S
authors.initials: LS
authors.lastname: Lutzke
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Borkenhagen
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000473:pathology; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery; D018709:Statistics, Nonparametric