Quantitative analysis of submucosal excision depth in endoscopic resection for early Barrett’s cancer

Abstract

Background Following endoscopic resection of early-stage Barrett’s esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens.

Methods In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated.

Results No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections.

Conclusion The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.

• References

• 1 Komanduri S, Muthusamy VR, Wani S. Controversies in endoscopic eradication therapy for Barrett's esophagus. Gastroenterology 2018; 154: 1861-1875.e1861
• 2 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett's esophagus. Am J Gastroenterol 2016; 111: 30-50
• 3 Pech O, May A, Manner H. et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660.e651
• 4 Yang D, Zou F, Xiong S. et al. Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis. Gastrointest Endosc 2018; 87: 1383-1393
• 5 Wani S, Muthusamy VR, Shaheen NJ. et al. Development of quality indicators for endoscopic eradication therapies in Barrett's esophagus: the TREAT-BE (Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus) Consortium. Gastrointest Endosc 2017; 86: 1-17.e13
• 6 Sharma P, Katzka DA, Gupta N. et al. Quality indicators for the management of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium. Gastroenterology 2015; 149: 1599-1606
• 7 Vieth M, Sterlacci W. Endoscopic resection: a pathologistʼs point of view! What affects specimen quality? . Minerva Chir 2018; 73: 437-443
• 8 Overwater A, van der Meulen KE, Künzli HT. et al. Optimizing histopathologic evaluation of EMR specimens of Barrett's esophagus-related neoplasia: a randomized study of 3 specimen handling methods. Gastrointest Endosc 2019; 90: 384-392.e385
• 9 Royal College of Pathologists. Standards and datasets for reporting cancers: Dataset for histopathological reporting of oesophageal and gastric carcinoma. 2019 https://www.rcpath.org/uploads/assets/f8b1ea3d-5529-4f85-984c8d4d8556e0b7/068e9093-0aea-4316-bdd49771564784b9/g006-dataset-for-histopathological-reporting-of-oesophageal-and-gastric-carcinoma.pdf Accessed: 17 September 2021
• 10 Schmitz R, Krause J, Krech T. et al. Virtual endoscopy based on 3-dimensional reconstruction of histopathology features of endoscopic resection specimens. Gastroenterology 2018; 154: 1234-1236.e1234
• 11 Bennett C, Vakil N, Bergman J. et al. Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143: 336-346
• 12 Clermont M, Falk GW. Clinical guidelines update on the diagnosis and management of Barrett's esophagus. Dig Dis Sci 2018; 63: 2122-2128
• 13 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
• 14 Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021; 24: 1-21
• 15 PDQ Adult Treatment Editorial Board. Gastric cancer treatment (PDQ): health professional version. PDQ Cancer Information Summaries. Bethesda, Maryland, USA: National Cancer Institute (US); 2021
• 16 Porschen R, Buck A, Fischbach W. et al. S3 guideline diagnosis and therapy of squamous cell and adenocarcinoma of the esophagus, version September 2015 (September 2015, AWMF registration no: 021/023OL). Z Gastroenterol 2015; 53: 1288-1347
• 17 Shaukat A, Kaltenbach T, Dominitz JA. et al. Endoscopic recognition and management strategies for malignant colorectal polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 92: 997-1015.e1011
• 18 Repici A, Wallace M, Sharma P. et al. A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial. Gastrointest Endosc 2018; 88: 527-535.e525
• 19 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia. Gut 2017; 66: 783-793
• 20 Litjens G, Kooi T, Bejnordi BE. et al. A survey on deep learning in medical image analysis. Med Image Anal 2017; 42: 60-88
• 21 Schmitz R, Madesta F, Nielsen M. et al. Multi-scale fully convolutional neural networks for histopathology image segmentation: From nuclear aberrations to the global tissue architecture. Med Image Anal 2021; 70: 101996