Definition of Barrett Esophagus in the United States
| Autor: | Yaman Tarabishy, Elizabeth A. Montgomery, Kevin M. Waters, Maryam Kherad Pezhouh, Marcia I. Canto, Kevan J. Salimian, Lysandra Voltaggio, Eun Ji Shin, Ogechukwu Eze |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Biopsy medicine.medical_treatment Gastroenterology Pathology and Forensic Medicine Barrett Esophagus Young Adult 03 medical and health sciences Esophagus 0302 clinical medicine Predictive Value of Tests Terminology as Topic Internal medicine Metaplasia medicine Humans Young adult Aged Retrospective Studies Aged 80 and over Chemotherapy medicine.diagnostic_test business.industry Intestinal metaplasia Retrospective cohort study Middle Aged medicine.disease medicine.anatomical_structure 030220 oncology & carcinogenesis Predictive value of tests Baltimore Female 030211 gastroenterology & hepatology Surgery Goblet Cells Anatomy medicine.symptom business |
| Zdroj: | American Journal of Surgical Pathology. 42:264-268 |
| ISSN: | 0147-5185 |
| DOI: | 10.1097/pas.0000000000000971 |
| Popis: | Barrett esophagus (BE) predisposes patients to the development of esophageal adenocarcinoma (EAC). However, the global definition of BE is controversial. Pathologists in Europe and the United States require intestinal metaplasia (IM) within columnar-lined mucosa (CLM) in the tubular esophagus to diagnose BE, whereas in the UK and Japan only the presence of CLM is required. To aid in establishing an appropriate definition for BE, we evaluated whether IM accompanies EAC in a US patient cohort. We examined a series of 139 consecutive patients who underwent endoscopic mucosal resections or esophagectomies for EAC performed at a US tertiary care center. The resection specimens were evaluated for the presence (IM+) or absence (IM-) of IM within CLM. Ninety-seven (70%) patients were IM+. Tumors found in IM- patients tended to be advanced at the time of resection (57% pT3 or greater, IM-; 31% pT3 or greater, IM+; P=0.02) such that the tumor may have "overgrown" zones of IM. We hypothesized that changes as a result of neoadjuvant chemotherapy or radiation might mask preexisting IM. When evaluating this hypothesis, we found that 34 of 39 of treatment-naive patients were IM+. Two of the 5 IM- patients had prior IM+ biopsies resulting in 92% of treatment-naive patients who were IM+. In our US hospital population, CLM with IM in the tubular esophagus is found in association with EAC in 70% to 92% of patients. We believe that based on these data the United States definition of BE should continue to require the presence of IM. |
| Databáze: | OpenAIRE |
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