The team investigated whether ulcers are markers for invasive carcinoma in Barrett's esophagus (BE).
They reported their findings in the January issue of the American Journal of Gastroenterology.
Follow-up information from 138 patients with BE and varying degrees of dysplasia was correlated with the presence of ulcers.
A group of pathologists were asked to contribute patients' initial biopsy slides BE without dysplasia, and with epithelial changes indefinite for dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and adenocarcinoma.
There were 44 cases submitted as BE, 22 as BE with epithelial changes indefinite for dysplasia, 26 as BE with LGD, 33 as BE with HGD, and 13 as BE with adenocarcinoma.
Ulcers were present in 35 of the 138 cases (25%). This included 7% of cases of BE without dysplasia, 9% of BE cases with epithelial changes indefinite for dysplasia, 0% of BE cases with LGD, 30% of BE cases with HGD, and 54% of BE cases with adenocarcinoma.
On median follow-up of 39 months, there were no invasive carcinomas detected among the BE without dysplasia group.
|HGD patients with carcinoma:|
With ulcers: 80%
Without ulcers: 52%
| American Journal of Gastroenterology |
Adenocarcinomas were detected in 4/22 cases (18%) submitted as BE with epithelial changes indefinite for dysplasia at 19, 55, 60, and 62 months, and in 4/26 cases (15%) of BE with LGD at 9, 9, 11, and 60 months.
None of these carcinomas occurred in cases in which an ulcer was present in the initial biopsy specimen.
Among the 33 HGD cases, 60% were found to have adenocarcinoma on subsequent resection specimens.
The researchers found that the presence of an ulcer with HGD increased the likelihood of finding carcinoma in the resection specimen, as 80% of HGD patients with ulcers had carcinoma, compared to 52% of HGD patients without ulcers.
All of the cases interpreted as adenocarcinomas on biopsy were found either to have invasive carcinoma on esophageal resection or to have metastases that were demonstrated in unresectable patients.
Author E. Montgomery, of the Johns Hopkins University, Baltimore, concluded on behalf of fellow colleagues, "If an ulcer accompanies HGD in a biopsy specimen from a patient with BE, it is likely that invasive carcinoma is also present at that time."