Yin-Kai Chao1,2, Chang-Yo Tsai1,2, Hsien-Kun Chang3,2, Chen-Kan Tseng4,2, Yun-Hen Liu1,2, Chi-Ju Yeh5,6. 1. Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. 2. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Division of Hematology/Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan. 4. Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan. 5. Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan. taki.yeh@gmail.com. 6. College of Medicine, Chang Gung University, Taoyuan, Taiwan. taki.yeh@gmail.com.
Abstract
BACKGROUND: Endoscopic biopsy examinations after neoadjuvant chemoradiotherapy (nCRT) are of limited value in patients with esophageal cancer due to the high rates of false negative (FN) findings. We sought to investigate the anatomical locations of residual tumors in esophageal squamous cell carcinoma (ESCC) patients with FN endoscopic biopsies with the ultimate goal of improving their clinical management. METHODS: ESCC patients with residual cancers after nCRT which were not identified by preoperative endoscopic biopsy were deemed eligible. All of the surgical specimens were re-reviewed with a special focus on (1) distribution of residual cancer in each esophageal layer; (2) tumor regression grade (TRG); and (3) shortest distance between the lumen and the residual tumor. RESULTS: Among the 49 ESCC patients with FN biopsy results, a strong 'layer-dependent' tumor regression was observed. There was a preferential clearing of esophageal cancer cells located in the adventitia, followed by muscle and the submucosal (SM) and mucosal (M) layers (p < 0.001). Residual malignancies located in the muscle layer or the adventitia without simultaneous involvement of the M/SM layers were rare (n = 3; 6.1 %). TRG following nCRT did not affect the rate of M/SM involvement (p = 0.55) but was inversely associated with the distance between the lumen and residual cancer (mean distance in patients with TRG of 2, 3, and 4 was 1.1, 0.82, and 0.37 mm, respectively; p = 0.041). CONCLUSION: Most ESCC patients who show FN endoscopic biopsies following nCRT still have detectable lesions in the M/SM layers. Aggressive biopsy protocols may potentially improve detection rates.
BACKGROUND: Endoscopic biopsy examinations after neoadjuvant chemoradiotherapy (nCRT) are of limited value in patients with esophageal cancer due to the high rates of false negative (FN) findings. We sought to investigate the anatomical locations of residual tumors in esophageal squamous cell carcinoma (ESCC) patients with FN endoscopic biopsies with the ultimate goal of improving their clinical management. METHODS:ESCCpatients with residual cancers after nCRT which were not identified by preoperative endoscopic biopsy were deemed eligible. All of the surgical specimens were re-reviewed with a special focus on (1) distribution of residual cancer in each esophageal layer; (2) tumor regression grade (TRG); and (3) shortest distance between the lumen and the residual tumor. RESULTS: Among the 49 ESCCpatients with FN biopsy results, a strong 'layer-dependent' tumor regression was observed. There was a preferential clearing of esophageal cancer cells located in the adventitia, followed by muscle and the submucosal (SM) and mucosal (M) layers (p < 0.001). Residual malignancies located in the muscle layer or the adventitia without simultaneous involvement of the M/SM layers were rare (n = 3; 6.1 %). TRG following nCRT did not affect the rate of M/SM involvement (p = 0.55) but was inversely associated with the distance between the lumen and residual cancer (mean distance in patients with TRG of 2, 3, and 4 was 1.1, 0.82, and 0.37 mm, respectively; p = 0.041). CONCLUSION: Most ESCCpatients who show FN endoscopic biopsies following nCRT still have detectable lesions in the M/SM layers. Aggressive biopsy protocols may potentially improve detection rates.
Authors: Shu Jie Huang; Dan Tian; Si Chao Wang; Rui Jie Zeng; Yue Jiao Dong; Liang Li Hong; Han Sheng Wu; Fang Ping Xu; Dong Kun Zhang; Liang Xie; Hai Yu Zhou; Ji Ming Tang; Xiao Song Ben; Gang Chen; Ri Xin Chen; Yong Tang; Gui Bin Qiao Journal: World J Oncol Date: 2022-08-23