Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia

Benjamin Michael Allanson, Jessica Bonavita, Bob Mirzai, Tze Sheng Khor, Spiro C. Raftopoulos, Willem Bastiaan De Boer, Ian S. Brown, Marian Priyanthi Kumarasinghe

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    Abstract

    The assumption that intestinal metaplasia is a prerequisite for intraepithelial neoplasia/dysplasia and adenocarcinoma in the distal esophagus has been challenged by observations of adenocarcinoma without associated intestinal metaplasia. This study describes our experience of intestinal metaplasia in association with early Barrett neoplasia in distal esophagus and gastroesophageal junction. We reviewed the first endoscopic mucosal resection of 139 patients with biopsy-proven neoplasia. In index endoscopic mucosal resection, 110/139 (79%) cases showed intestinal metaplasia. Seven had intestinal metaplasia on prior biopsy specimens and three had intestinal metaplasia in subsequent specimens, totaling 120/139 (86%) patients showing intestinal metaplasia at some point supporting the theory of sampling error for absence of intestinal metaplasia in some cases. Those without intestinal metaplasia (13%) were enriched for higher stage disease (T1a Stolte m2 or above) supporting the assertion of obliteration of intestinal metaplasia by the advancing carcinoma. All cases of intraepithelial neoplasia and T1a Stolte m1 carcinomas had intestinal metaplasia (42/42). The average density of columnar-lined mucosa showing goblet cells was significantly less in shorter segments compared to those ≥3 cm (0.31 vs 0.51, P=0.0304). Cases where segments measured less than 1 cm were seen in a higher proportion of females and also tended to lack intestinal metaplasia. We conclude that early Barrett neoplasia is always associated with intestinal metaplasia; absence of intestinal metaplasia is attributable to sampling error or obliteration of residual intestinal metaplasia by neoplasia and those with segments less than 1 cm show atypical features for Barrett-related disease (absent intestinal metaplasia and female gender), supporting that gastroesophageal junction adenocarcinomas are heterogeneous.

    Original languageEnglish
    Pages (from-to)1170-1176
    Number of pages7
    JournalModern Pathology
    Volume30
    Issue number8
    DOIs
    Publication statusPublished - 1 Aug 2017

    Fingerprint

    Barrett Esophagus
    Metaplasia
    Neoplasms
    Esophagogastric Junction
    Adenocarcinoma
    Selection Bias
    Esophagus
    Carcinoma
    Biopsy
    Intestinal Diseases
    Goblet Cells

    Cite this

    Allanson, B. M., Bonavita, J., Mirzai, B., Khor, T. S., Raftopoulos, S. C., De Boer, W. B., ... Kumarasinghe, M. P. (2017). Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia. Modern Pathology, 30(8), 1170-1176. https://doi.org/10.1038/modpathol.2017.36
    Allanson, Benjamin Michael ; Bonavita, Jessica ; Mirzai, Bob ; Khor, Tze Sheng ; Raftopoulos, Spiro C. ; De Boer, Willem Bastiaan ; Brown, Ian S. ; Kumarasinghe, Marian Priyanthi. / Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia. In: Modern Pathology. 2017 ; Vol. 30, No. 8. pp. 1170-1176.
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    title = "Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia",
    abstract = "The assumption that intestinal metaplasia is a prerequisite for intraepithelial neoplasia/dysplasia and adenocarcinoma in the distal esophagus has been challenged by observations of adenocarcinoma without associated intestinal metaplasia. This study describes our experience of intestinal metaplasia in association with early Barrett neoplasia in distal esophagus and gastroesophageal junction. We reviewed the first endoscopic mucosal resection of 139 patients with biopsy-proven neoplasia. In index endoscopic mucosal resection, 110/139 (79{\%}) cases showed intestinal metaplasia. Seven had intestinal metaplasia on prior biopsy specimens and three had intestinal metaplasia in subsequent specimens, totaling 120/139 (86{\%}) patients showing intestinal metaplasia at some point supporting the theory of sampling error for absence of intestinal metaplasia in some cases. Those without intestinal metaplasia (13{\%}) were enriched for higher stage disease (T1a Stolte m2 or above) supporting the assertion of obliteration of intestinal metaplasia by the advancing carcinoma. All cases of intraepithelial neoplasia and T1a Stolte m1 carcinomas had intestinal metaplasia (42/42). The average density of columnar-lined mucosa showing goblet cells was significantly less in shorter segments compared to those ≥3 cm (0.31 vs 0.51, P=0.0304). Cases where segments measured less than 1 cm were seen in a higher proportion of females and also tended to lack intestinal metaplasia. We conclude that early Barrett neoplasia is always associated with intestinal metaplasia; absence of intestinal metaplasia is attributable to sampling error or obliteration of residual intestinal metaplasia by neoplasia and those with segments less than 1 cm show atypical features for Barrett-related disease (absent intestinal metaplasia and female gender), supporting that gastroesophageal junction adenocarcinomas are heterogeneous.",
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    Allanson, BM, Bonavita, J, Mirzai, B, Khor, TS, Raftopoulos, SC, De Boer, WB, Brown, IS & Kumarasinghe, MP 2017, 'Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia' Modern Pathology, vol. 30, no. 8, pp. 1170-1176. https://doi.org/10.1038/modpathol.2017.36

    Early Barrett esophagus-related neoplasia in segments 1cm or longer is always associated with intestinal metaplasia. / Allanson, Benjamin Michael; Bonavita, Jessica; Mirzai, Bob; Khor, Tze Sheng; Raftopoulos, Spiro C.; De Boer, Willem Bastiaan; Brown, Ian S.; Kumarasinghe, Marian Priyanthi.

    In: Modern Pathology, Vol. 30, No. 8, 01.08.2017, p. 1170-1176.

    Research output: Contribution to journalArticle

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    AU - Allanson, Benjamin Michael

    AU - Bonavita, Jessica

    AU - Mirzai, Bob

    AU - Khor, Tze Sheng

    AU - Raftopoulos, Spiro C.

    AU - De Boer, Willem Bastiaan

    AU - Brown, Ian S.

    AU - Kumarasinghe, Marian Priyanthi

    PY - 2017/8/1

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    N2 - The assumption that intestinal metaplasia is a prerequisite for intraepithelial neoplasia/dysplasia and adenocarcinoma in the distal esophagus has been challenged by observations of adenocarcinoma without associated intestinal metaplasia. This study describes our experience of intestinal metaplasia in association with early Barrett neoplasia in distal esophagus and gastroesophageal junction. We reviewed the first endoscopic mucosal resection of 139 patients with biopsy-proven neoplasia. In index endoscopic mucosal resection, 110/139 (79%) cases showed intestinal metaplasia. Seven had intestinal metaplasia on prior biopsy specimens and three had intestinal metaplasia in subsequent specimens, totaling 120/139 (86%) patients showing intestinal metaplasia at some point supporting the theory of sampling error for absence of intestinal metaplasia in some cases. Those without intestinal metaplasia (13%) were enriched for higher stage disease (T1a Stolte m2 or above) supporting the assertion of obliteration of intestinal metaplasia by the advancing carcinoma. All cases of intraepithelial neoplasia and T1a Stolte m1 carcinomas had intestinal metaplasia (42/42). The average density of columnar-lined mucosa showing goblet cells was significantly less in shorter segments compared to those ≥3 cm (0.31 vs 0.51, P=0.0304). Cases where segments measured less than 1 cm were seen in a higher proportion of females and also tended to lack intestinal metaplasia. We conclude that early Barrett neoplasia is always associated with intestinal metaplasia; absence of intestinal metaplasia is attributable to sampling error or obliteration of residual intestinal metaplasia by neoplasia and those with segments less than 1 cm show atypical features for Barrett-related disease (absent intestinal metaplasia and female gender), supporting that gastroesophageal junction adenocarcinomas are heterogeneous.

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