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. 2007 Nov;102(11):2380-6.
doi: 10.1111/j.1572-0241.2007.01419.x. Epub 2007 Jul 19.

Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett's esophagus

Ganapathy A Prasad  1 , Navtej S Buttar, Louis M Wongkeesong, Jason T Lewis, Schuyler O Sanderson, Lori S Lutzke, Lynn S Borkenhagen, Kenneth K Wang
Affiliations

Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett's esophagus

Ganapathy A Prasad et al. Am J Gastroenterol. 2007 Nov.

Abstract

Objectives: 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%).

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Conflict of interest statement

CONFLICT OF INTEREST

Guarantor of the article: Kenneth K. Wang, M.D.

Specific author contributions: G. A. Prasad: Manuscript preparation and revision, data extraction, statistical analysis; K. K. Wang: Concept, manuscript revision, guarantor, primary endoscopist, senior and corresponding author; N. S. Buttar: Manuscript revision, clinical care of patients; L. M. Wongkeesong: Manuscript revision, clinical care of patients; J. T. Lewis: Interpreration of pathology specimens; S. O. Sanderson: Interpretation of pathology specimens; L. S. Lutzke: Data extraction, clinical care of patients; L. S. Borkenhagen: Clinical care of patients, data extraction.

Figures

Figure 1
Figure 1
Intramucosal adenocarinoma confined by muscularis mucosae. There is a lymphoid aggregate at the lower right corner of the field. No invasion into submucosa is present.
Figure 2
Figure 2
Negative margin showing gastric cardio-oxyntic mucosa. No specialized Barrett mucosa is present.
Figure 3
Figure 3
High grade dysplasia at a lateral mucosal margin. While there is significant atypia present within these glands, there is no effacement of the lamina propria or significant gland fusion to qualify as carcinoma.
Figure 4
Figure 4
Deep margin involved by carcinoma. There are malignant glands and single cells present within mucin pools which are present along the deep margin of the specimen.
See this image and copyright information in PMC

References

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