Dataset Information

How should extra-large Lugol-unstained lesions of the esophagus be treated? Results from a population-based cohort study.

ABSTRACT:

Background

Current guidelines recommend only severe dysplasia and above (SDA) lesions of the esophageal squamous epithelium for clinical intervention. However, the histopathologic diagnosis derived from tissue biopsies may be subject to underestimation of severity.

Methods

1073 participants from whom biopsies were taken at baseline chromoendoscopic examination in a population-based screening trial were enrolled in this study. The size of the Lugol-unstained lesions (LULs) was mainly analyzed. The outcome was defined as SDA lesions either identified at baseline screening, or during follow-up, collectively referred to as the cumulative risk of SDA. Multivariable logistic regression models were used to evaluate the cumulative risk of SDA.

Results

One hundred and forty-six SDA cases were identified in the study period. Participants with large LULs had a high cumulative incidence of SDA (cumulative incidence_16-20mm : 55.88%; cumulative incidence_>20mm : 76.92%) in the median of 7-year duration. LULs of large size were significantly associated with a higher cumulative risk of SDA, regardless of the pathologic diagnosis (adjusted OR_{16-20mmvs.≤5mm} = 21.02, 95% CI: 7.56-58.47; adjusted OR_{>20mmvs.≤5mm} = 33.62, 95% CI: 11.79-95.87).

Conclusions

Results from this study suggest physician-patient shared decision-making regarding clinical treatment or intensive surveillance should be carried out for LULs >20 mm in the esophagus, regardless of the histologic diagnosis. For those with LULs of 16-20 mm, intensive surveillance would also best be considered.

SUBMITTER: Liu M

PROVIDER: S-EPMC10587922 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

How should extra-large Lugol-unstained lesions of the esophagus be treated? Results from a population-based cohort study.

Liu Mengfei M Qi Zifan Z Zhou Ren R Guo Chuanhai C Liu Anxiang A Yang Haijun H Li Fenglei F Duan Liping L Shen Lin L Wu Qi Q Liu Zhen Z Pan Yaqi Y Liu Fangfang F Liu Ying Y Cai Hong H He Zhonghu Z Ke Yang Y

Cancer medicine 20230921 19

<h4>Background</h4>Current guidelines recommend only severe dysplasia and above (SDA) lesions of the esophageal squamous epithelium for clinical intervention. However, the histopathologic diagnosis derived from tissue biopsies may be subject to underestimation of severity.<h4>Methods</h4>1073 participants from whom biopsies were taken at baseline chromoendoscopic examination in a population-based screening trial were enrolled in this study. The size of the Lugol-unstained lesions (LULs) was main ...[more]

PMID: 37732496

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Project description:Background & aimsIt is a challenge to detect dysplasia in Barrett's esophagus (BE) and esophageal adenocarcinomas (EACs) are missed in 25%-33% of cases. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or EAC detection during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with BE. However, current estimates are from referral center cohorts, which might overestimate NDR. Effects on rates of missed dysplasia are also unknown. We analyzed data from a large cohort of patients with BE to estimate the NDR and factors associated with it, and assess the effects of the NDR on the rate of missed dysplasia.MethodsWe analyzed data from 1066 patients in the Rochester Epidemiology Project-linked medical record system, a population-based cohort of patients with BE (confirmed by review of the endoscopic and histologic reports) from 11 southeastern Minnesota counties from 1991 through 2019. Biopsies reported to contain dysplasia were confirmed by expert gastrointestinal pathologists. The NDR was calculated as the rate of HGD or EAC detected by histologic analyses of biopsies collected during the first surveillance endoscopy. Patients without HGD or EAC at their initial endoscopy (n = 391) underwent repeat endoscopy within 12 months; HGD or EAC detected at the repeat endoscopy were considered to be missed on index endoscopy. Factors associated with NDR and missed dysplasia were identified using univariate and multivariate logistic regression models.ResultsThe NDR was 4.9% (95% CI, 3.8-6.4); 3.1% of patients had HGD, 1.8% had EAC, and 10.6% had low-grade dysplasia. Factors associated with higher rates of detection of neoplasia included older age, male sex, smoking, increasing length of BE, and surveillance endoscopies by gastroenterologists. This NDR was associated with a substantially lower rate of missed dysplasia (13%).ConclusionsIn an analysis of 1066 patients with BE in a population-based cohort, we found a lower NDR and lower rate of missed dysplasia than previously reported. NDR may have value as a quality metric in BE surveillance if validated in other cohorts.

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Dataset Information

How should extra-large Lugol-unstained lesions of the esophagus be treated? Results from a population-based cohort study.

Background

Methods

Results

Conclusions

Publications

How should extra-large Lugol-unstained lesions of the esophagus be treated? Results from a population-based cohort study.

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