Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

Dhingra, Sadhna; Bahdi, Firas; May, Sarah; Othman, Mohamed O.

doi:10.1186/s13000-021-01169-1

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…The studies are small, retrospective, and use different definitions and criteria for the quantification of tumor budding. Nevertheless, they indicate a positive correlation between tumor budding and aggressive clinical behavior [155][156][157][158][159][160]. Owing to the lack of solid data, ESGE does not however recommend routine use of tumor budding in the assessment of endoscopically treated EAC.…”

Section: Tumor Buddingmentioning

confidence: 99%

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Weusten,

Bisschops,

Dinis-Ribeiro

et al. 2023

Endoscopy

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Main Recommendations MR1 ESGE recommends the following standards for Barrett esophagus (BE) surveillance:– a minimum of 1-minute inspection time per cm of BE length during a surveillance endoscopy– photodocumentation of landmarks, the BE segment including one picture per cm of BE length, and the esophagogastric junction in retroflexed position, and any visible lesions– use of the Prague and (for visible lesions) Paris classification– collection of biopsies from all visible abnormalities (if present), followed by random four-quadrant biopsies for every 2-cm BE length.Strong recommendation, weak quality of evidence. MR2 ESGE suggests varying surveillance intervals for different BE lengths. For BE with a maximum extent of ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE with a maximum extent of ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent of ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies. For patients with an irregular Z-line/columnar-lined esophagus of < 1 cm, no routine biopsies or endoscopic surveillance are advised.Weak recommendation, low quality of evidence. MR3 ESGE suggests that, if a patient has reached 75 years of age at the time of the last surveillance endoscopy and/or the patient’s life expectancy is less than 5 years, the discontinuation of further surveillance endoscopies can be considered. Weak recommendation, very low quality of evidence. MR4 ESGE recommends offering endoscopic eradication therapy using ablation to patients with BE and low grade dysplasia (LGD) on at least two separate endoscopies, both confirmed by a second experienced pathologist.Strong recommendation, high level of evidence. MR5 ESGE recommends endoscopic ablation treatment for BE with confirmed high grade dysplasia (HGD) without visible lesions, to prevent progression to invasive cancer.Strong recommendation, high level of evidence. MR6 ESGE recommends offering complete eradication of all remaining Barrett epithelium by ablation after endoscopic resection of visible abnormalities containing any degree of dysplasia or esophageal adenocarcinoma (EAC).Strong recommendation, moderate quality of evidence. MR7 ESGE recommends endoscopic resection as curative treatment for T1a Barrett’s cancer with well/moderate differentiation and no signs of lymphovascular invasion.Strong recommendation, high level of evidence. MR8 ESGE suggests that low risk submucosal (T1b) EAC (i. e. submucosal invasion depth ≤ 500 µm AND no [lympho]vascular invasion AND no poor tumor differentiation) can be treated by endoscopic resection, provided that adequate follow-up with gastroscopy, endoscopic ultrasound (EUS), and computed tomography (CT)/positrion emission tomography-computed tomography (PET-CT) is performed in expert centers.Weak recommendation, low quality of evidence. MR9 ESGE suggests that submucosal (T1b) esophageal adenocarcinoma with deep submucosal invasion (tumor invasion > 500 µm into the submucosa), and/or (lympho)vascular invasion, and/or a poor tumor differentiation should be considered high risk. Complete staging and consideration of additional treatments (chemotherapy and/or radiotherapy and/or surgery) or strict endoscopic follow-up should be undertaken on an individual basis in a multidisciplinary discussion.Strong recommendation, low quality of evidence. MR10 a ESGE recommends that the first endoscopic follow-up after successful endoscopic eradication therapy (EET) of BE is performed in an expert center.Strong recommendation, very low quality of evidence. b ESGE recommends careful inspection of the neo-squamocolumnar junction and neo-squamous epithelium with high definition white-light endoscopy and virtual chromoendoscopy during post-EET surveillance, to detect recurrent dysplasia.Strong recommendation, very low level of evidence. c ESGE recommends against routine four-quadrant biopsies of neo-squamous epithelium after successful EET of BE.Strong recommendation, low level of evidence. d ESGE suggests, after successful EET, obtaining four-quadrant random biopsies just distal to a normal-appearing neo-squamocolumnar junction to detect dysplasia in the absence of visible lesions.Weak recommendation, low level of evidence. e ESGE recommends targeted biopsies are obtained where there is a suspicion of recurrent BE in the tubular esophagus, or where there are visible lesions suspicious for dysplasia.Strong recommendation, very low level of evidence. MR11 After successful EET, ESGE recommends the following surveillance intervals:– For patients with a baseline diagnosis of HGD or EAC:at 1, 2, 3, 4, 5, 7, and 10 years after last treatment, after which surveillance may be stopped.– For patients with a baseline diagnosis of LGD:at 1, 3, and 5 years after last treatment, after which surveillance may be stopped.Strong recommendation, low quality of evidence.

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Section: Tumor Buddingmentioning

confidence: 99%

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Weusten,

Bisschops,

Dinis-Ribeiro

et al. 2023

Endoscopy

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“…single cells or clusters of <5 cancer cells) and the tumor immune micro-environment, which have been identified as prognostic factors in various gastrointestinal tumors [38][39][40][41][42]. In a few retrospective studies, high-grade tumor budding in early EACs has been described as an independent risk factor for LNM and poor prognosis [38,[43][44][45]. Moreover, some studies have also reported a significant correlation of certain immune cell types with LNM and survival rates [46 & ,47 & ,48].…”

Section: New Risk Stratification Criteria Are Neededmentioning

confidence: 99%

Towards personalized management of early esophageal adenocarcinoma

Bos,

Chan,

Pouw

2024

Current Opinion in Gastroenterology

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Purpose of review This review aims to discuss recent advancements in the endoscopic management of early esophageal adenocarcinoma (T1 EAC). Recent findings Patients with high-risk EAC (defined by the presence of deep submucosal invasion, and/or lymphovascular invasion, and/or poor differentiation) have a higher risk of lymph node metastases than those with low-risk EAC. However, more recent, endoscopically-focused studies report a lower risk of lymph node metastases and distant metastases for high-risk EAC than previously assumed. Instead of referring all high-risk EAC patients for esophagectomy after a radical endoscopic resection, an alternative approach involving regular upper endoscopy with endoscopic ultrasound may allow for detection of intra-luminal recurrence and lymph node metastases at an early and potentially curable stage. Summary Endoscopic resection of mucosal and submucosal EAC might prove to be safe and curative for selected cases in the future, when followed by a strict follow-up protocol. Despite the promising results of preliminary studies, there is an ongoing need for personalized strategies and new risk stratification methods to decide on the best management for individual patients with high-risk T1 EAC.

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“…Previous studies have found that ESCC with low TIL exhibits aggressive clinical behavior and is associated with a poor prognosis 16 . In addition, it modifies the effectiveness of TB alone in providing an indication for the prognosis of tumors 17–20 . The evaluation indexes of TIL are diverse and large differences between evaluation units exist 21–26 .…”

Section: Introductionmentioning

confidence: 99%

“… 16 In addition, it modifies the effectiveness of TB alone in providing an indication for the prognosis of tumors. 17 , 18 , 19 , 20 The evaluation indexes of TIL are diverse and large differences between evaluation units exist. 21 , 22 , 23 , 24 , 25 , 26 For repeatability and cost efficiency of evaluation strategies, morphometrical measurement remains a highly efficient evaluation method of TIL in ESCC.…”

Section: Introductionmentioning

confidence: 99%

Tumor budding and tumor‐infiltrating lymphocytes can predict prognosis in pT1b esophageal squamous cell carcinoma

Liu

Wang

et al. 2023

Thoracic Cancer

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BackgroundTumor budding (TB) and tumor‐infiltrating lymphocyte (TIL) are significant predictive indicators of lymph node metastasis (LNM) and unfavorable prognosis in various tumors. Currently, there is no gold standard for TB and TIL evaluation in esophageal squamous cell carcinoma (ESCC). This study aimed to identify the standard of TB and TIL evaluations and build a predictive model for prognosis among patients with pT1b ESCC.MethodsWe retrospectively analyzed the prognostic values of TB and TIL in 150 pT1b ESCC cases. Hematoxylin and eosin (H&E) and immunohistochemistry (IHC) of anti‐pan cytokeratin (AE1/AE3) were used to analyze the threshold of TB, and intratumoral TIL and peritumoral TIL (pTIL) were evaluated using the receiver operating characteristic curves (ROC).ResultsWe found that TB in a three‐tiered grading system (low‐TB: 0‐4; middle‐TB: 5–15; high‐TB: ≥16) displayed an excellent prognosis prediction for LNM and survival based on IHC staining using a 20× objective lens. Low pTIL level (≤20%) was a significant indicator of LNM and unfavorable prognosis (p < 0.05). Moreover, lower tumor location and lymphovascular invasion (LVI) were correlated with an unfavorable prognosis (p < 0.05). A nomogram developed based on TB, pTIL, LVI, and tumor location showed good discrimination, as shown by the area under the ROC and calibration curves.ConclusionWe therefore recommend identifying TB using a 20× objective lens under IHC staining and TIL adjacent to the tumor. Additionally, a nomogram was built for facilitating individualized prediction of survival for patients with pT1b ESCC.

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Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

Cited by 11 publications

References 28 publications

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Towards personalized management of early esophageal adenocarcinoma

Tumor budding and tumor‐infiltrating lymphocytes can predict prognosis in pT1b esophageal squamous cell carcinoma

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