Optimal management of Barrett’s esophagus complicated by high grade dysplasia is controversial.
|57% of patients had unsuspected cancer at the time of esophagectomy.|
Extent of high grade dysplasia has been described as a predictor of subsequent development of cancer. However, there is no universal agreement on the definition of extent of high grade dysplasia.
In this study, researchers from Cleveland, Ohio, assessed whether extent of high grade dysplasia in Barrett’s esophagus is a predictor of the presence of adenocarcinoma at the time of esophagectomy.
The team identified 42 patients with Barrett’s esophagus and high grade dysplasia.
These patients had undergone esophagectomy between 1985 and 1999.
Researchers reviewed pathological specimens, including preoperative endoscopic biopsies and post-esophagectomy sections, to determine the extent of high grade dysplasia.
The team defined the extent of high grade dysplasia using 2 separate criteria, 1 from the Cleveland Clinic and 1 from the Mayo Clinic.
The research team found that 57% of patients had unsuspected cancer at the time of esophagectomy.
Using the Cleveland Clinic criteria, 48% patients with focal high grade dysplasia had carcinoma, compared to 67% with diffuse high grade dysplasia.
When the team used the Mayo Clinic criteria, adenocarcinoma was found in 72% of patients with focal high grade dysplasia, compared with 54% with diffuse high grade dysplasia.
Dr Dar’s team concluded, “The extent of high grade dysplasia, regardless of how it is defined, does not predict the presence of unsuspected adenocarcinoma at esophagectomy”.
“There is no evidence as yet that the extent of high grade dysplasia can be used as a basis for decision making in these patients.”