Ravi S. Shah , Omar Alaber , Xuefeng Zhang , Abel Joseph , Siva Raja , Suneel Kamath , Ruishen Lyu , John J. Vargo , Sudish C. Murthy , Amitabh Chak , Amit Bhatt
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引用次数: 0
Abstract
Background and Aims
Endoscopic resection (ER) can be a curative treatment for early esophageal adenocarcinoma (EAC). Poor tumor differentiation is a histologic feature of noncurative ER and, when seen on preoperative biopsies, may lead to avoidance of endoscopic treatment. However, the accuracy of tumor grade on preoperative endoscopic biopsies remains unclear. The aim of this study was to determine the accuracy of tumor differentiation on endoscopic forceps biopsy compared with endoscopically or surgically resected tissue.
Methods
This retrospective cohort study from 2 tertiary referral centers compared tumor differentiation from preoperative biopsies with endoscopically or surgically resected EAC samples. Accuracy (%) of preoperative biopsy and agreement analyses (Gwet's AC2) were performed.
Results
In total, 346 EAC lesions (225 esophagectomies, 121 ERs) were included. The overall accuracy and reliability of EAC grade on preoperative biopsies compared with postoperative tissue from ER or esophagectomy was 74% (114/154), with a substantial agreement coefficient (Gwet's AC2 0.78 [0.72-0.85]; P < 0.001). The accuracy of ER was only 56%, with moderate agreement (Gwet's AC2 0.60 [0.46-0.73]; P < 0.001). Poorly differentiated tumors were downgraded to moderately differentiated in 19.6% (20/102) of tumors, and conversely, moderately differentiated tumors were upgraded to poorly differentiated in 22.7% (37/163) of tumors. For patients with T1a tumors, poorly differentiated tumors on preoperative biopsies were downgraded to moderately differentiated tumors in 40% (4/10) of cases after resection.
Conclusions
The accuracy of tumor grade of EAC on preprocedural biopsies is suboptimal and should not be depended upon solely to make decisions regarding endoscopic treatment.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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