title: Prediction of adenocarcinoma in esophagectomy specimens based upon analysis of preresection biopsies of Barrett esophagus with at least high-grade dysplasia: a comparison of 2 systems.
abstract: Distinguishing Barrett esophagus with high-grade dysplasia (BE-HGD) from intramucosal and submucosal adenocarcinomas on biopsies is challenging, yet important, in the choice of therapy. The current study evaluates preresection biopsies from patients who underwent esophagectomy for at least BE-HGD, to compare the recently published histologic categories by the University of Michigan (UM) and Cleveland Clinic (CC), correlate preresection and final resection diagnosis, and identify histologic features in biopsies that might be predictive of adenocarcinoma on esophagectomy. A total of 112 cases with a consensus biopsy diagnosis (agreement by ≥4 of 7 gastrointestinal pathologists) were statistically analyzed to identify histologic features that predicted adenocarcinoma on resection. Applying the UM criteria to the biopsy series showed excellent agreement with the CC system (κ=0.86) and significant correlation between preoperative and esophagectomy diagnoses (P<0.001). The likelihood of finding carcinoma on resection was significantly higher with the category of HGD with marked glandular distortion cannot exclude intramucosal adenocarcinoma [CC; odd ratio (OR), 2.8; P=0.046] or HGD suspicious for adenocarcinoma (UM; OR, 4.3; P=0.008), compared to HGD alone. The presence of "never-ending" glands (OR, 3.7; P=0.008), sheet-like growth (P<0.001), angulated glands (OR, 8.5; P<0.001), ≥3 dilated glands with intraluminal debris (OR, 2.6; P=0.05), and >1 focus of single-cell infiltration into the lamina propria (OR, 8.9; P<0.001) increased the odds of finding carcinoma on resection. The latter 2 variables remained independent predictors of adenocarcinoma in multivariable analysis. In conclusion, the CC and UM systems show excellent agreement and define histologic categories that can improve prediction of adenocarcinoma on resection.
authors: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA. patild@ccf.org
authors: Deepa T
authors: DT
authors: Patil
authors: John R
authors: JR
authors: Goldblum
authors: Lisa
authors: L
authors: Rybicki
authors: Thomas P
authors: TP
authors: Plesec
authors: Joel E
authors: JE
authors: Mendelin
authors: Ana E
authors: AE
authors: Bennett
authors: Elias A
authors: EA
authors: Castilla
authors: Walter H
authors: WH
authors: Henricks
authors: Lynn
authors: L
authors: Schoenfield
authors: Marek
authors: M
authors: Skacel
authors: Lisa M
authors: LM
authors: Yerian
authors: Thomas W
authors: TW
authors: Rice
authors: Mary P
authors: MP
authors: Bronner
authors: Erinn
authors: E
authors: Downs-Kelly
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000601:surgery; D001706:Biopsy; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010340:Pathology, Surgical / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011230:Precancerous Conditions / Q000175:diagnosis / Q000601:surgery; D015203:Reproducibility of Results