title: Expert pathology review and endoscopic mucosal resection alters the diagnosis of patients referred to undergo therapy for Barrett's esophagus.
abstract: BACKGROUND
  Endoscopic therapy has emerged as an alternative to surgical esophagectomy for the management of Barrett's esophagus (BE)-associated neoplasia. Accurate pretreatment staging is essential to ensure an appropriate choice of therapy and optimal long-term outcomes. This study aimed to assess the frequency with which expert histopathologic review of biopsies combined with endoscopic mucosal resection (EMR) would alter the pretreatment diagnosis of BE-associated neoplasia.
  
  
  METHODS
  Patients referred to the Vanderbilt Barrett's Esophagus Endoscopic Treatment Program (V-BEET) were retrospectively identified. Demographic, histopathologic, and endoscopic data were extracted from the medical record.
  
  
  RESULTS
  For this study, 29 subjects referred for endoscopic staging of BE fulfilled the entry criteria. The referral diagnosis was low-grade dysplasia (LGD) in 3 % (1/29), high-grade dysplasia (HGD) in 62 % (18/29), intramucosal adenocarcinoma (T1a) adenocarcinoma in 17 % (5/29), and invasive adenocarcinoma in 17 % (5/29) of the subjects. Expert histopathologic review of available referral biopsy specimens altered the diagnosis in 33 % (5/15) of the cases. Further diagnostic staging with EMR showed BE without dysplasia in 10 % (3/29), LGD in 14 % (4/29), HGD in 34 % (10/29), T1a adenocarcinoma in 28 % (8/29), and invasive adenocarcinoma in 14 % (4/29) of the patients. The combination of expert histopathologic review and EMR altered the initial diagnosis for 55 % (16/29) of the subjects, with 56 % (9/16) upstaged to more advanced disease and 44 % (7/16) downstaged to less advanced disease.
  
  
  CONCLUSIONS
  The practice of combined expert histopathologic review and EMR alters the pretreatment diagnosis for the majority of patients with BE-associated neoplasia. Caution is advised for those embarking on endoscopic or surgical treatment for BE-associated neoplasia in the absence of these staging methods.
authors: Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, Nashville, TN 37232-5280, USA.
authors: Katie
authors: K
authors: Ayers
authors: Chanjuan
authors: C
authors: Shi
authors: Kay
authors: K
authors: Washington
authors: Patrick
authors: P
authors: Yachimski
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D011230:Precancerous Conditions; D012017:Referral and Consultation; D012189:Retrospective Studies
references: Clin Gastroenterol Hepatol. 2010 Mar;8(3):248-53
references: 19948247
references: Ann Surg. 1996 May;223(5):585-9; discussion 589-91
references: 8651749
references: Gastroenterology. 2002 May;122(6):1569-91
references: 12016424
references: Gastroenterology. 2011 Mar;140(3):1084-91
references: 21376940
references: Clin Gastroenterol Hepatol. 2008 Nov;6(11):1206-11
references: 18619919
references: Ann Thorac Surg. 2005 Apr;79(4):1110-5; discussion 1110-5
references: 15797034
references: Gastrointest Endosc. 2007 Sep;66(3):460-8
references: 17643436
references: Am J Gastroenterol. 1993 Nov;88(11):1832-6
references: 8237928
references: Am J Gastroenterol. 2010 Jun;105(6):1276-83
references: 20179694
references: Br J Surg. 2000 Aug;87(8):1102-5
references: 10931058
references: Gastrointest Endosc. 1999 Jul;50(1):23-6
references: 10385717
references: Clin Gastroenterol Hepatol. 2010 Dec;8(12):1037-41
references: 20831900
references: J Biomed Inform. 2009 Apr;42(2):377-81
references: 18929686
references: Eur J Cardiothorac Surg. 2005 Nov;28(5):763-6
references: 16188449
references: Ann Surg. 1996 Jul;224(1):66-71
references: 8678620
references: Am J Gastroenterol. 2012 Jun;107(6):850-62; quiz 863
references: 22488081
references: Gastroenterology. 2011 Oct;141(4):1179-86, 1186.e1
references: 21723218
references: J Thorac Cardiovasc Surg. 1997 Nov;114(5):824-9
references: 9375613
references: Gastrointest Endosc. 2009 Apr;69(4):777-83
references: 19136106
references: N Engl J Med. 2009 May 28;360(22):2277-88
references: 19474425
references: Gastrointest Endosc. 2011 Dec;74(6):1201-6
references: 22000793
references: Gastrointest Endosc. 2008 Mar;67(3):394-8
references: 18045592
references: Gastroenterology. 2012 Aug;143(2):336-46
references: 22537613
references: Ann Surg. 1999 Sep;230(3):433-8; discussion 438-40
references: 10493489