Accurate staging of high-grade dysplasia and of early cancer in Barrett's esophagus is important in the selection of patients for endoscopic therapy.
Dr Charles Lightdale and colleagues from New York staged patients with Barrett's esophagus and biopsy specimen proven high-grade dysphasia using endoscopic ultrasonography.
Patients with adenocarcinoma in focal nodular lesions or in endoscopically unapparent flat lesions in short-segment Barrett's esophagus were also initially staged with endoscopes ultrasonography.
The team performed cap-assisted endoscopic mucosal resection in patients with disease limited to the mucosa on endoscopic ultrasound.
The depth of tumor invasion on endoscopic mucosal resection
specimens was classified in a similar manner to squamous-cell cancer of the esophagus.
The researcher‘s classification of the depth of tumor invasion included m1 as epithelial layer or dysplasia, m2 as lamina propria invasion, m3 as muscularis mucosae invasion, and sm as submucosal invasion.
The team performed endoscopic ultrasound in 48 consecutive patients, of which 27 had focal nodular lesions and 21 had microscopic lesions.
|Endoscopic mucosal resection confirmed epithelial layer or dysplasia disease in 19 of 25 patients |
The research team diagnosed submucosal invasion in 8 patients and endoscopic mucosal resection
was carried out in the remaining 40 patients without significant complications.
In the 25 patients with high-grade dysplasia on prior biopsy specimens, endoscopic mucosal resection confirmed m1 disease in 19, whereas in 6, invasive adenocarcinoma was detected.
The research team found that in the 15 patients with invasive cancer on prior biopsy specimens and staging with endoscopic ultrasound, intramucosal carcinoma was confirmed in 9.
However, in 6 of these patients, submucosal invasion was found.
Overall, the team noted that endoscopic ultrasound provided accurate staging in 41 of the 48 patient with 1 patient overstaged and 6 patients understaged.
The researchers compared these results with pathologic staging obtained by surgery or endoscopic mucosal resection.
Of the 34 patients with m1 to m3 staging after endoscopic mucosal resection, 29 were treated endoscopically and had no evidence of cancer after a mean follow-up of 23 months.
Dr Lightdale's team concludes, “Endoscopic mucosal resection provides pathologic staging information”
“In addition, it may be helpful after endoscopic ultrasound if a stage-determined approach is used in the management of high-grade dysplasia and of early cancer in Barrett's esophagus.”
“Endoscopic mucosal resection may be particularly useful for staging of focal nodules or in short-segment Barrett's esophagus with microscopic lesions when endoscopic therapy is an option.”