The poorly differentiated component in endoscopic biopsy predicts submucosal invasion in superficial Barrett's...

Endoscopic prediction of depth of invasion in superficial Barrett's esophageal adenocarcinoma (s-BEA) is important for treatment selection. This study aimed to evaluate the endoscopic and histopathological characteristics in s-BEA demonstrating submucosal invasion.

We retrospectively reviewed 105 tumors from 97 patients, diagnosed endoscopically and pathologically with s-BEA in short-segment Barrett's esophagus (60 lesions in 60 patients) and long-segment Barrett's esophagus (45 lesions in 37 patients); 105 s-BEA lesions were classified into 60 intramucosal and 45 submucosal tumors. We compared the clinicopathological and endoscopic characteristics of these tumors. A multivariate analysis was conducted to predict submucosal invasion based on pretreatment endoscopic and histopathological findings. The presence of the poorly differentiated component (PDC) was then assessed histologically in both pretreatment biopsy specimens (biopsy-PDC) and resected specimens.

Compared to intramucosal tumors, submucosal tumors demonstrated significantly higher frequency of the following features: biopsy-PDC (21/45, 46.7%; versus 1/60, 1.7%; odds ratio = 24.9), complex macroscopic type (33/45, 73.3%; versus 15/60, 25.0%; odds ratio = 6.26), and tumor diameter > 20 mm (31/45, 68.9%; versus 13/60, 21.7%; odds ratio = 7.63). In 20 submucosal tumors with biopsy-PDC, the invasion at the biopsy site showed PDC extended to the submucosa in 95.0% (19/20) and was limited to the mucosa in 5.0% (1/20) cases.

We showed biopsy-PDC, tumor diameter greater than 20 mm, and complex macroscopic type independently predict submucosal invasion in Barrett's esophageal adenocarcinoma. Biopsy-PDC may predict submucosal cancer and submucosal invasion at the biopsy site more reliably, independent of endoscopic findings.