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Accuracy of identification of tissue types in endoscopic esophageal mucosal biopsies used for molecular biology studies.

Beck P, Mayne GC, Astill D, Irvine T, Watson DI, Dijckmeester WA, Wijnhoven BP, Hussey DJ - Clin Exp Gastroenterol (2009)

Bottom Line: On 59 (70.2%) metaplastic columnar-lined epithelium levels and on 62 (46%) columnar-lined epithelium with intestinal metaplasia levels, tissue heterogeneity was observed in clinical histopathology, with portions of squamous epithelium within the samples.Matches with pure tissue samples in both clinical and research histopathology levels were observed on 22 (26.2%) levels of metaplastic columnar-lined epithelium and in 55 (40.7%) levels of columnar-lined epithelium with intestinal metaplasia.The high proportion of mismatches and tissue heterogeneity observed, especially among columnar-lined epithelium with intestinal metaplasia and dysplasia, points to the necessity of determining the histopathology of the research samples to avoid sampling errors during molecular studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery.

ABSTRACT

Objectives: To determine if histopathologic assessment of esophageal biopsies harvested for research study is justified due to the heterogeneity of tissues in the esophagus, and the consequent histopathologic mis-matches with the clinical histopathology of biopsies taken at the same level.

Methods: Since 2004, patients undergoing upper endoscopy for a variety of clinical conditions were invited to provide additional esophageal biopsies; those were collected for research purpose at the same level as biopsies collected for clinical histopathology. Research biopsies were cut in two parts: one part was submitted to research histopathology and the other stored for molecular analysis. Results of clinical histopathology for each patient were summarized per biopsy level and compared to results obtained from research biopsies at the corresponding level.

Results: A total of 377 level summaries were obtained from 137 patients. Clinical histopathology summaries classified 123 levels (32.6%) as squamous epithelium, 84 levels (22.3%) as metaplastic columnar-lined epithelium, 135 levels (35.8%) as columnar-lined epithelium with intestinal metaplasia, 30 levels (8%) as dysplasia, and 5 levels (1.3%) as adenocarcinoma. Research histopathology matched to clinical summaries on 120 of 123 (97.5%) levels for squamous epithelium, 52 of 84 (61.9%) for metaplastic columnar-lined epithelium, and 94 of 135 (69.5%) for columnar-lined epithelium with intestinal metaplasia. There were no matches for dysplasia between the groups; however, they agreed on all five cases of AC. On 59 (70.2%) metaplastic columnar-lined epithelium levels and on 62 (46%) columnar-lined epithelium with intestinal metaplasia levels, tissue heterogeneity was observed in clinical histopathology, with portions of squamous epithelium within the samples. Matches with pure tissue samples in both clinical and research histopathology levels were observed on 22 (26.2%) levels of metaplastic columnar-lined epithelium and in 55 (40.7%) levels of columnar-lined epithelium with intestinal metaplasia.

Conclusions: The high proportion of mismatches and tissue heterogeneity observed, especially among columnar-lined epithelium with intestinal metaplasia and dysplasia, points to the necessity of determining the histopathology of the research samples to avoid sampling errors during molecular studies.

No MeSH data available.


Related in: MedlinePlus

Sections of esophageal epithelium from matched research and clinical biopsies from the esophagus. Research biopsy sections are shown on the left panel and the matched clinical biopsy sections are on the right panel. A–F are sections stained with ABPAS/D. G–L are sections stained with H&E. A and B show stratified squamous epithelium, C and D show columnar lined epithelium without intestinal metaplasia, E and F show columnar-lined epithelium with intestinal metaplasia, G and H show changes consistent with low grade dysplasia, I and J represent carcinoma in-situ, and K and L show invasive cancer.
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f1-ceg-2-001: Sections of esophageal epithelium from matched research and clinical biopsies from the esophagus. Research biopsy sections are shown on the left panel and the matched clinical biopsy sections are on the right panel. A–F are sections stained with ABPAS/D. G–L are sections stained with H&E. A and B show stratified squamous epithelium, C and D show columnar lined epithelium without intestinal metaplasia, E and F show columnar-lined epithelium with intestinal metaplasia, G and H show changes consistent with low grade dysplasia, I and J represent carcinoma in-situ, and K and L show invasive cancer.

Mentions: To assess the tissue type identified in the fragments of the research biopsies, we compared the diagnosis from biopsies collected for clinical histopathology with that for the histopathology from the research biopsy fragments, when both types of biopsy were obtained from the equivalent level in the esophagus; ie, the same distance from the gastroesophageal junction. In addition, to assess inter- and intra-observer variability, all slides from clinical samples reported to contain dysplastic tissues, and the corresponding slides from research samples were reviewed again by the pathologist. For this analysis the pathologist was blinded to the first diagnosis. Representative sections of each tissue type from matched clinical and research biopsies are shown in Figure 1.


Accuracy of identification of tissue types in endoscopic esophageal mucosal biopsies used for molecular biology studies.

Beck P, Mayne GC, Astill D, Irvine T, Watson DI, Dijckmeester WA, Wijnhoven BP, Hussey DJ - Clin Exp Gastroenterol (2009)

Sections of esophageal epithelium from matched research and clinical biopsies from the esophagus. Research biopsy sections are shown on the left panel and the matched clinical biopsy sections are on the right panel. A–F are sections stained with ABPAS/D. G–L are sections stained with H&E. A and B show stratified squamous epithelium, C and D show columnar lined epithelium without intestinal metaplasia, E and F show columnar-lined epithelium with intestinal metaplasia, G and H show changes consistent with low grade dysplasia, I and J represent carcinoma in-situ, and K and L show invasive cancer.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108633&req=5

f1-ceg-2-001: Sections of esophageal epithelium from matched research and clinical biopsies from the esophagus. Research biopsy sections are shown on the left panel and the matched clinical biopsy sections are on the right panel. A–F are sections stained with ABPAS/D. G–L are sections stained with H&E. A and B show stratified squamous epithelium, C and D show columnar lined epithelium without intestinal metaplasia, E and F show columnar-lined epithelium with intestinal metaplasia, G and H show changes consistent with low grade dysplasia, I and J represent carcinoma in-situ, and K and L show invasive cancer.
Mentions: To assess the tissue type identified in the fragments of the research biopsies, we compared the diagnosis from biopsies collected for clinical histopathology with that for the histopathology from the research biopsy fragments, when both types of biopsy were obtained from the equivalent level in the esophagus; ie, the same distance from the gastroesophageal junction. In addition, to assess inter- and intra-observer variability, all slides from clinical samples reported to contain dysplastic tissues, and the corresponding slides from research samples were reviewed again by the pathologist. For this analysis the pathologist was blinded to the first diagnosis. Representative sections of each tissue type from matched clinical and research biopsies are shown in Figure 1.

Bottom Line: On 59 (70.2%) metaplastic columnar-lined epithelium levels and on 62 (46%) columnar-lined epithelium with intestinal metaplasia levels, tissue heterogeneity was observed in clinical histopathology, with portions of squamous epithelium within the samples.Matches with pure tissue samples in both clinical and research histopathology levels were observed on 22 (26.2%) levels of metaplastic columnar-lined epithelium and in 55 (40.7%) levels of columnar-lined epithelium with intestinal metaplasia.The high proportion of mismatches and tissue heterogeneity observed, especially among columnar-lined epithelium with intestinal metaplasia and dysplasia, points to the necessity of determining the histopathology of the research samples to avoid sampling errors during molecular studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery.

ABSTRACT

Objectives: To determine if histopathologic assessment of esophageal biopsies harvested for research study is justified due to the heterogeneity of tissues in the esophagus, and the consequent histopathologic mis-matches with the clinical histopathology of biopsies taken at the same level.

Methods: Since 2004, patients undergoing upper endoscopy for a variety of clinical conditions were invited to provide additional esophageal biopsies; those were collected for research purpose at the same level as biopsies collected for clinical histopathology. Research biopsies were cut in two parts: one part was submitted to research histopathology and the other stored for molecular analysis. Results of clinical histopathology for each patient were summarized per biopsy level and compared to results obtained from research biopsies at the corresponding level.

Results: A total of 377 level summaries were obtained from 137 patients. Clinical histopathology summaries classified 123 levels (32.6%) as squamous epithelium, 84 levels (22.3%) as metaplastic columnar-lined epithelium, 135 levels (35.8%) as columnar-lined epithelium with intestinal metaplasia, 30 levels (8%) as dysplasia, and 5 levels (1.3%) as adenocarcinoma. Research histopathology matched to clinical summaries on 120 of 123 (97.5%) levels for squamous epithelium, 52 of 84 (61.9%) for metaplastic columnar-lined epithelium, and 94 of 135 (69.5%) for columnar-lined epithelium with intestinal metaplasia. There were no matches for dysplasia between the groups; however, they agreed on all five cases of AC. On 59 (70.2%) metaplastic columnar-lined epithelium levels and on 62 (46%) columnar-lined epithelium with intestinal metaplasia levels, tissue heterogeneity was observed in clinical histopathology, with portions of squamous epithelium within the samples. Matches with pure tissue samples in both clinical and research histopathology levels were observed on 22 (26.2%) levels of metaplastic columnar-lined epithelium and in 55 (40.7%) levels of columnar-lined epithelium with intestinal metaplasia.

Conclusions: The high proportion of mismatches and tissue heterogeneity observed, especially among columnar-lined epithelium with intestinal metaplasia and dysplasia, points to the necessity of determining the histopathology of the research samples to avoid sampling errors during molecular studies.

No MeSH data available.


Related in: MedlinePlus