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Factors associated with false-negative endoscopic biopsy results after neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma.

Chao YK, Yeh CJ, Lee MH, Wen YW, Chang HK, Tseng CK, Liu YH - Medicine (Baltimore) (2015)

Bottom Line: However, data on the factors associated with FN biopsy results remain scarce.A total of 227 patients were selected, of which 92 (41.9%) had positive biopsy results.Among patients with negative biopsy findings (n = 135), 85 were found to have residual cancer on the resected esophagus.

View Article: PubMed Central - PubMed

Affiliation: From the Division of Thoracic and Cardiovascular Surgery (Y-KC, Y-HL); Department of Pathology (C-JY); Division of Gastroenterology (M-HL); Clinical Informatics and Medical Statistics Research Center (Y-WW); Division of Hematology/Oncology (H-KC); and Department of Radiation Oncology (C-KT), Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

ABSTRACT
The usefulness of endoscopic biopsy following neoadjuvant chemoradiotherapy (nCRT) is limited because of its high false-negative (FN) rates. However, data on the factors associated with FN biopsy results remain scarce. The purpose of this study was to investigate factors associated with FN results on endoscopic biopsies in patients with esophageal squamous cell carcinoma (ESCC) following nCRT. We retrospectively reviewed the records of ESCC patients who were treated at the Chang Gung Memorial Hospital, Taoyuan, Taiwan, between 1999 and 2013. Inclusion criteria were receiving nCRT as first-line treatment before esophagectomy and having been preoperatively submitted to an endoscopic biopsy. Endoscopic findings at the lesion site were classified into 6 distinct categories: stricture, tumor, ulcer, scar, other findings, or normal. Univariate and multivariate analyses were used to identify factors associated with FN biopsy findings. A total of 227 patients were selected, of which 92 (41.9%) had positive biopsy results. Among patients with negative biopsy findings (n = 135), 85 were found to have residual cancer on the resected esophagus. Multivariate analysis identified endoscopic findings as the only independent predictor of FN biopsy results. The negative predictive values were 77.8%, 61.9%, 52.6%, 30.3%, 23.1%, and 20.0% for the normal, scar, other findings, ulcer, stricture, and tumor categories, respectively (P < 0.001). In ESCC patients, the FN rate of endoscopic biopsy after nCRT is associated with the type of residual lesion.

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Decision process during endoscopic examination and representative picture of each category.
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Figure 1: Decision process during endoscopic examination and representative picture of each category.

Mentions: Restaging endoscopic evaluations were performed by 3 experienced gastroenterologists (Yin-Yi Chu, Mu-Hsien Lee, and Cheng-Tung Chiu, Division of Gastroenterology, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan) who were blinded to the results of all other staging procedures. Classification of the endoscopic findings into the 6 categories is summarized in Figure 1. Briefly, a standard endoscope (9.8 mm in diameter) was used to evaluate the esophagus, and a classification of “stricture” was assigned when the endoscope failed to pass through the site of the original esophageal lesion.17 If no stricture was present, a through endoscopic examination was performed to determine classifications of “tumor,” if any residual tumor was found, of “ulcer,” if an active ulcer was found, or of “scar,” if the ulcer was healed. The remaining abnormal mucosal findings (eg, mucosa tag, polypoid lesion, granular protruded lesions, erosion, and lugol-voiding lesions) were classified as “other findings.” Finally, patients who did not show any mucosal abnormality were classified as “normal.”


Factors associated with false-negative endoscopic biopsy results after neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma.

Chao YK, Yeh CJ, Lee MH, Wen YW, Chang HK, Tseng CK, Liu YH - Medicine (Baltimore) (2015)

Decision process during endoscopic examination and representative picture of each category.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554138&req=5

Figure 1: Decision process during endoscopic examination and representative picture of each category.
Mentions: Restaging endoscopic evaluations were performed by 3 experienced gastroenterologists (Yin-Yi Chu, Mu-Hsien Lee, and Cheng-Tung Chiu, Division of Gastroenterology, Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan) who were blinded to the results of all other staging procedures. Classification of the endoscopic findings into the 6 categories is summarized in Figure 1. Briefly, a standard endoscope (9.8 mm in diameter) was used to evaluate the esophagus, and a classification of “stricture” was assigned when the endoscope failed to pass through the site of the original esophageal lesion.17 If no stricture was present, a through endoscopic examination was performed to determine classifications of “tumor,” if any residual tumor was found, of “ulcer,” if an active ulcer was found, or of “scar,” if the ulcer was healed. The remaining abnormal mucosal findings (eg, mucosa tag, polypoid lesion, granular protruded lesions, erosion, and lugol-voiding lesions) were classified as “other findings.” Finally, patients who did not show any mucosal abnormality were classified as “normal.”

Bottom Line: However, data on the factors associated with FN biopsy results remain scarce.A total of 227 patients were selected, of which 92 (41.9%) had positive biopsy results.Among patients with negative biopsy findings (n = 135), 85 were found to have residual cancer on the resected esophagus.

View Article: PubMed Central - PubMed

Affiliation: From the Division of Thoracic and Cardiovascular Surgery (Y-KC, Y-HL); Department of Pathology (C-JY); Division of Gastroenterology (M-HL); Clinical Informatics and Medical Statistics Research Center (Y-WW); Division of Hematology/Oncology (H-KC); and Department of Radiation Oncology (C-KT), Chang Gung Memorial Hospital, Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

ABSTRACT
The usefulness of endoscopic biopsy following neoadjuvant chemoradiotherapy (nCRT) is limited because of its high false-negative (FN) rates. However, data on the factors associated with FN biopsy results remain scarce. The purpose of this study was to investigate factors associated with FN results on endoscopic biopsies in patients with esophageal squamous cell carcinoma (ESCC) following nCRT. We retrospectively reviewed the records of ESCC patients who were treated at the Chang Gung Memorial Hospital, Taoyuan, Taiwan, between 1999 and 2013. Inclusion criteria were receiving nCRT as first-line treatment before esophagectomy and having been preoperatively submitted to an endoscopic biopsy. Endoscopic findings at the lesion site were classified into 6 distinct categories: stricture, tumor, ulcer, scar, other findings, or normal. Univariate and multivariate analyses were used to identify factors associated with FN biopsy findings. A total of 227 patients were selected, of which 92 (41.9%) had positive biopsy results. Among patients with negative biopsy findings (n = 135), 85 were found to have residual cancer on the resected esophagus. Multivariate analysis identified endoscopic findings as the only independent predictor of FN biopsy results. The negative predictive values were 77.8%, 61.9%, 52.6%, 30.3%, 23.1%, and 20.0% for the normal, scar, other findings, ulcer, stricture, and tumor categories, respectively (P < 0.001). In ESCC patients, the FN rate of endoscopic biopsy after nCRT is associated with the type of residual lesion.

Show MeSH
Related in: MedlinePlus