Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct;4(5):663-668.
doi: 10.1177/2050640615626320. Epub 2016 Jan 6.

Oesophageal biopsies are insufficient to predict final histology after endoscopic resection in early Barrett's neoplasia

E Werbrouck  1 , G De Hertogh  2 , X Sagaert  2 , G Coremans  3 , H Willekens  3 , I Demedts  3 , R Bisschops  3
Affiliations

Oesophageal biopsies are insufficient to predict final histology after endoscopic resection in early Barrett's neoplasia

E Werbrouck et al. United European Gastroenterol J. 2016 Oct.

Abstract

Background: Endoscopic resection (ER) with or without ablation is the first choice treatment for early Barrett's neoplasia. Adequate staging is important to assure a good oncological outcome.

Objective: The purpose of this study was to investigate the diagnostic accuracy of pre-operative biopsies in patients who undergo ER for high-grade dysplasia (HGD) or early adenocarcinoma (EAC) in Barrett's oesophagus (BE) and the cardia.

Methods: Between November 2005-May 2012, 142 ERs performed in 137 patients were obtained. Worst pre-ER and ER histology were compared. Upgrading/downgrading was defined as any more/less severe histological grading on the ER specimen.

Results: The accuracy of pre-ER biopsies in predicting final histology was 61%. ER changed the pre-treatment diagnosis in 55 of the 142 procedures (39%) with downgrading in 23 cases (16%) and upgrading from HGD to T1a or T1b in 32 cases (23%). In the majority of upgraded cases, a visible lesion according to the Paris classification could be detected (26/32, 81%).

Conclusion: The diagnostic accuracy of oesophageal biopsies alone in predicting final pathology in Barrett's dysplasia is only 61%. The majority of upgraded lesions are detectable. When ablative therapy is considered in HGD Barrett's dysplasia a meticulous inspection for and removal of all small visible lesions is mandatory.

Keywords: Accuracy; Barrett; biopsy; histology.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Endoscopic resection (ER) specimen marked with Indian ink along the lateral and deep margins, stretched and pinned to a wax block.
See this image and copyright information in PMC

References

    1. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005; 97: 142–146. - PubMed
    1. Sharma P. Clinical practice. Barrett’s esophagus. N Engl J Med 2009; 361: 2548–2556. - PubMed
    1. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 1375–1383. - PubMed
    1. Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett’s esophagus: The AGA Chicago Workshop. Gastroenterology 2004; 127: 310–330. - PubMed
    1. Wani S, Mathur SC, Curvers WL, et al. Greater interobserver agreement by endoscopic mucosal resection than biopsy samples in Barrett’s dysplasia. Clin Gastroenterol Hepatol 2010; 8: 783–788. - PubMed