Prevalence of adenocarcinoma at esophagectomy for Barrett's esophagus with high grade dysplasia

Background: Barrett's esophagus with high grade dysplasia (HGD) may require surgical resection because of the risk of concomitant adenocarcinoma. The prevalence of invasive, occult carcinoma (≥stage 1B) in this setting has varied. We investigated the association of adenocarcinoma at operative resection for high grade dysplasia.

Methods: Using an electronic medical record, we identified patients who underwent esophagectomy for high grade dysplasia at the University of Pittsburgh Medical Center between 1993 and 2007. Preoperative diagnosis was confirmed by reviewing endoscopic, radiologic and pathology reports. Postoperative pathology reports were compared to the preoperative diagnosis.

Results: 68 patients (12 females and 56 males) with a preoperative diagnosis of high grade dysplasia underwent operative resection. The mean age was 64 years (range 36 to 86 years). Of 68 patients, 12 (17.6%) had adenocarcinoma, 2 (2.9%) were downgraded to low grade dysplasia, and 54 (79.4%) were confirmed as HGD. Of the 12 patients with adenocarcinoma, 4 (5.9% of total cohort) had intramucosal cancer (Stage 1A) and 8 (11.7% of total cohort) had invasive cancer with submucosal invasion or more advanced disease. Of the 8 patients with invasive adenocarcinoma, 4 did not have preoperative endoscopic or radiologic testing suggestive of advanced disease.

Conclusion: The overall prevalence of adenocarcinoma in association with a preoperative diagnosis of HGD was 17.6%. Invasive adenocarcinoma was present in 11.7% of subjects and was clinically occult in 5.9%.