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Diagnostic Pathology

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Open Access 01-12-2021 | Esophagus Resection | Research

Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

Authors: Sadhna Dhingra, Firas Bahdi, Sarah B. May, Mohamed O. Othman

Published in: Diagnostic Pathology | Issue 1/2021

Abstract

Background

Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). The western pathologists’ experience with ESD specimens remains limited. This study aimed to correlate histopathologic features of Barrett’s esophagus (BE)-associated adenocarcinoma in ESD resections with clinical outcomes to determine whether they aid future management decisions.

Methods

We retrospectively evaluated 49 consecutive ESD resection specimens from 42 patients with BE-associated adenocarcinoma (24 intramucosal and 18 submucosal EAC) at a single tertiary referral center. Pathologic evaluation included presence of dysplasia, invasive adenocarcinoma, peritumoral inflammation, desmoplasia, lymphovascular and perineural invasion; tumor differentiation, depth of invasion, morphology, and budding; and margin status for dysplasia or carcinoma. Follow up data included endoscopic biopsies in 35 patients and pathology reports of esophagectomies in 11 patients. Poor outcomes were defined as recurrence or residual invasive adenocarcinoma at esophagectomy, metastasis on imaging, or R1 resection in patients undergoing ESD for tumor debulking.

Results

Two patients (8%) with intramucosal adenocarcinoma and 9 patients (50%) with submucosal adenocarcinoma had poor outcomes. Histopathologic features associated with poor outcomes included poor differentiation, lymphovascular invasion, submucosal invasion > 500 μm, tumor budding, and tubuloinfiltrative histologic pattern. Four patients had positive deep margin away from the deepest tumor invasion and did not show residual tumor on follow up.

Conclusions

Our results validated European Society of Gastroenterology (ESGE) guidelines of high-risk pathologic features for additional therapy in esophageal adenocarcinoma and identified tumor budding frequently in association with other high-risk features. Positive deep margin distant from deepest tumor invasion could be procedural and warrants endoscopic correlation for management.

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Title: Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens
Authors: Sadhna Dhingra
Firas Bahdi
Sarah B. May
Mohamed O. Othman
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Esophagus Resection
Esophagus Resection
Barrett Esophagus
Published in: Diagnostic Pathology / Issue 1/2021
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-021-01169-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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