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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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Related in: MedlinePlus

Flow diagram of patient selection. CRT = chemoradiotherapy, PES = panendoscopy, SCC, squamous cell carcinoma.
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Figure 2: Flow diagram of patient selection. CRT = chemoradiotherapy, PES = panendoscopy, SCC, squamous cell carcinoma.

Mentions: A flow diagram of patient selection is shown in Figure 2. Between January 1999 and October 2013, we identified a total of 457 ESCC patients who underwent nCRT followed by surgery. Of those, 227 underwent endoscopic biopsy before surgery. The decision to perform this biopsy was made by the treating oncologists based on clinical judgment. General characteristics of the entire cohort are summarized in Table 1. There were 222 males and 5 females, with a mean age of 55.6 years (range, 31–78 years). Most tumors occurred in the middle-third of the esophagus (59%, 134/227). According to the results of esophagography, the mean pretreatment tumor length was 6.1 cm (range, 1.5–16 cm). Sixty (26.7%) of the 227 patients achieved local pCR (ypT0). Among them, 54 had complete pCR (ypT0N0). The Ivor-Lewis procedure was used in 168 individuals, whereas the McKeown procedure was used in 59 individuals. Reconstruction was performed using the stomach in 219 patients and colon interposition in 8 patients.


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)

Flow diagram of patient selection. CRT = chemoradiotherapy, PES = panendoscopy, SCC, squamous cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Flow diagram of patient selection. CRT = chemoradiotherapy, PES = panendoscopy, SCC, squamous cell carcinoma.
Mentions: A flow diagram of patient selection is shown in Figure 2. Between January 1999 and October 2013, we identified a total of 457 ESCC patients who underwent nCRT followed by surgery. Of those, 227 underwent endoscopic biopsy before surgery. The decision to perform this biopsy was made by the treating oncologists based on clinical judgment. General characteristics of the entire cohort are summarized in Table 1. There were 222 males and 5 females, with a mean age of 55.6 years (range, 31–78 years). Most tumors occurred in the middle-third of the esophagus (59%, 134/227). According to the results of esophagography, the mean pretreatment tumor length was 6.1 cm (range, 1.5–16 cm). Sixty (26.7%) of the 227 patients achieved local pCR (ypT0). Among them, 54 had complete pCR (ypT0N0). The Ivor-Lewis procedure was used in 168 individuals, whereas the McKeown procedure was used in 59 individuals. Reconstruction was performed using the stomach in 219 patients and colon interposition in 8 patients.

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