Biopsy is inadequate for precise diagnosis of neoplasia in patients with Barrett's esophagus
Magdalena Stefanová Orcid.org 1, Inna Tučková Orcid.org 2, Jana Malušková Orcid.org 3, Marek Kollár Orcid.org 4, Julius Špičák Orcid.org 4, Jan Martínek Orcid.org 4,5
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Summary
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: 17x early adenocarcinoma (EAC), two squamous carcinoma (SCC), 36x high-grade dysplasia (HGD), and 23x 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.
Keywords
Barrett’s oesophagus, endoscopic resection, neoplasmsTo read this article in full, please register for free on this website.
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