Significance of post-chemoradiation biopsy in predicting residual esophageal carcinoma in the surgical specimen

Q. Yang, K. R. Cleary, J. C. Yao, S. G. Swisher, J. A. Roth, P. M. Lynch, R. Komaki, J. A. Ajani, A. Rashid, S. R. Hamilton, Tsung Teh Wu

Research output: Contribution to journalArticle

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Abstract

Pathologic complete response in the resected esophagus can be achieved in ∼30% of patients with locally advanced esophageal or gastroesophageal junction carcinoma after preoperative chemoradiation therapy. These patients tend to have a longer survival than those who have less than pathologic complete response. Post-chemoradiation esophageal biopsy (PCEB) is used to check for the presence of residual tumor before a definitive resection is performed, but the clinical significance of PCEB findings is not clear due to the possibility of sampling bias and the superficial nature of the specimen obtained. We evaluated the use of PCEB (defined as biopsy taken within 30 days before esophagectomy) in predicting residual cancer in post-treatment esophagectomy specimens. PCEB was performed in 65 of 183 (36%) patients with locally advanced esophageal or gastroesophageal junction carcinoma, who received preoperative chemoradiation therapy. The cancer status in PCEB was correlated with the residual cancer in the esophagectomy specimens. PCEB had no cancer in 80% (52 of 65) of patients (Bx-negative) and cancer in 20% (13 of 65) of patients (Bx-positive). There was no difference in the presence of residual cancer (either in esophagus or lymph node) in esophagectomy specimens between Bx-negative patients (77%, 40 of 52) or Bx-positive patients (92%, 12 of 13), P = 0.44. The positive predictive value of biopsy was 92% (12 of 13), negative predictive value 23% (12 of 52), sensitivity 23% (12 of 52) and specificity 92% (12 of 13). There was no difference in the residual cancer staging in the esophagectomy specimen between Bx-positive and Bx-negative patients. In contrast, residual metastatic carcinoma in lymph nodes was more frequent in Bx-positive patients (69.2%, 9 of 13) than in Bx-negative patients (28.8%, 15 of 52), P = 0.01. Our data suggest that PCEB is a specific but not a sensitive predictor of residual cancer following esophagectomy. Bx-positive patients tend to have more frequent residual tumor in lymph nodes. The utility of PCEB in predicting residual cancer in the lymph nodes needs to be explored further along with molecular predictors of response to preoperative therapy.

Original languageEnglish (US)
Pages (from-to)38-43
Number of pages6
JournalDiseases of the Esophagus
Volume17
Issue number1
DOIs
StatePublished - 2004
Externally publishedYes

Fingerprint

Residual Neoplasm
Carcinoma
Biopsy
Esophagectomy
Lymph Nodes
Esophagogastric Junction
Esophagus
Neoplasms
Selection Bias
Neoplasm Staging
Therapeutics
Survival

Keywords

  • Biopsy
  • Carcinoma
  • Chemoradiation
  • Esophagus
  • Residual tumor

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Significance of post-chemoradiation biopsy in predicting residual esophageal carcinoma in the surgical specimen. / Yang, Q.; Cleary, K. R.; Yao, J. C.; Swisher, S. G.; Roth, J. A.; Lynch, P. M.; Komaki, R.; Ajani, J. A.; Rashid, A.; Hamilton, S. R.; Wu, Tsung Teh.

In: Diseases of the Esophagus, Vol. 17, No. 1, 2004, p. 38-43.

Research output: Contribution to journalArticle

Yang, Q, Cleary, KR, Yao, JC, Swisher, SG, Roth, JA, Lynch, PM, Komaki, R, Ajani, JA, Rashid, A, Hamilton, SR & Wu, TT 2004, 'Significance of post-chemoradiation biopsy in predicting residual esophageal carcinoma in the surgical specimen', Diseases of the Esophagus, vol. 17, no. 1, pp. 38-43. https://doi.org/10.1111/j.1442-2050.2004.00355.x
Yang, Q. ; Cleary, K. R. ; Yao, J. C. ; Swisher, S. G. ; Roth, J. A. ; Lynch, P. M. ; Komaki, R. ; Ajani, J. A. ; Rashid, A. ; Hamilton, S. R. ; Wu, Tsung Teh. / Significance of post-chemoradiation biopsy in predicting residual esophageal carcinoma in the surgical specimen. In: Diseases of the Esophagus. 2004 ; Vol. 17, No. 1. pp. 38-43.
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AU - Cleary, K. R.

AU - Yao, J. C.

AU - Swisher, S. G.

AU - Roth, J. A.

AU - Lynch, P. M.

AU - Komaki, R.

AU - Ajani, J. A.

AU - Rashid, A.

AU - Hamilton, S. R.

AU - Wu, Tsung Teh

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N2 - Pathologic complete response in the resected esophagus can be achieved in ∼30% of patients with locally advanced esophageal or gastroesophageal junction carcinoma after preoperative chemoradiation therapy. These patients tend to have a longer survival than those who have less than pathologic complete response. Post-chemoradiation esophageal biopsy (PCEB) is used to check for the presence of residual tumor before a definitive resection is performed, but the clinical significance of PCEB findings is not clear due to the possibility of sampling bias and the superficial nature of the specimen obtained. We evaluated the use of PCEB (defined as biopsy taken within 30 days before esophagectomy) in predicting residual cancer in post-treatment esophagectomy specimens. PCEB was performed in 65 of 183 (36%) patients with locally advanced esophageal or gastroesophageal junction carcinoma, who received preoperative chemoradiation therapy. The cancer status in PCEB was correlated with the residual cancer in the esophagectomy specimens. PCEB had no cancer in 80% (52 of 65) of patients (Bx-negative) and cancer in 20% (13 of 65) of patients (Bx-positive). There was no difference in the presence of residual cancer (either in esophagus or lymph node) in esophagectomy specimens between Bx-negative patients (77%, 40 of 52) or Bx-positive patients (92%, 12 of 13), P = 0.44. The positive predictive value of biopsy was 92% (12 of 13), negative predictive value 23% (12 of 52), sensitivity 23% (12 of 52) and specificity 92% (12 of 13). There was no difference in the residual cancer staging in the esophagectomy specimen between Bx-positive and Bx-negative patients. In contrast, residual metastatic carcinoma in lymph nodes was more frequent in Bx-positive patients (69.2%, 9 of 13) than in Bx-negative patients (28.8%, 15 of 52), P = 0.01. Our data suggest that PCEB is a specific but not a sensitive predictor of residual cancer following esophagectomy. Bx-positive patients tend to have more frequent residual tumor in lymph nodes. The utility of PCEB in predicting residual cancer in the lymph nodes needs to be explored further along with molecular predictors of response to preoperative therapy.

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