341. THE PREDICTION STRATEGY OF SUBMUCOSAL INVASION IN SUPERFICIAL BARRETT’S ADENOCARCINOMA BY THE COMBINATION OF HISTOLOGY IN BIOPSY AND MAGNIFYING ENDOSCOPY
Ken Namikawa, Junko Fujisaki, Hiroshi Kawachi- Gastroenterology
- General Medicine
Abstract
Background
Endoscopically predicting the depth of invasion of superficial Barrett’s esophageal adenocarcinoma (s-BEA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics to diagnose s-BEA with submucosal invasion.
Methods
We retrospectively reviewed 105 tumors from 97 patients endoscopically and pathologically diagnosed with s-BEA in short-segment Barrett’s esophagus (SSBE) (60 lesions in 60 patients) and long-segment Barrett’s esophagus (LSBE) (45 lesions in 37 patients). One hundred five s-BEA lesions were classified into 60 intramucosal (pT1a) tumors and 45 submucosal (pT1b) tumors. Clinicopathological and endoscopic characteristics, including the histology in the biopsy specimens, were analyzed with comparison in pT1a vs pT1b tumors. The histology in the biopsy specimens was classified into two types such as the presence or absence of poorly differentiated component (PDC). Risk factors for submucosal invasion identified using univariate analysis were entered into a multivariate logistic regression analysis. Subsequently, the findings of magnifying endoscopy with narrow-band imaging (ME-NBI) were assessed to determine whether the poorly differentiated component (PDC) in the resected specimens can be identified or not.
Results
pT1b tumors showed significantly higher frequency than pT1a tumors in the following features: PDC in the biopsy specimens (21/45, 46.7%; vs 1/60, 1.7%; OR = 24.8), complex macroscopic type (33/45, 73.3%; vs 15/60, 25.0%; OR = 4.47), and tumor diameter > 20 mm (31/45, 68.9%; vs 13/60, 21.7%; OR = 4.40). In 87 tumors which were able to be evaluated for endoscopic findings with ME-NBI, 9 out of 11 tumors with corkscrew pattern or wavy micro-vessels showed PDC in the resected specimens. The sensitivity, specificity, and positive predicted value of these irregular vessels for predicting PDC in the resected specimens were 40.9%, 96.9%, and 81.8%, respectively.
Conclusion
PDC in the biopsy specimens, tumor diameter > 20 mm, and complex macroscopic type were independent predictors for submucosal invasion of BEA. The presence of PDC in the biopsy specimens was an especially useful predictor of T1b cancer with the highest odds. Further, ME-NBI can be useful to diagnose the presence of PDC in BEA.