Definition of Barrett Esophagus in the United States: Support for Retention of a Requirement for Goblet Cells

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.

Source: The American Journal of Surgical Pathology - January 17, 2018 Category: Pathology Tags: Original Articles Source Type: research