Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy

Ruben D. Van Der Bogt, Berend J. Van Der Wilk, Lindsey Oudijk, Erik J. Schoon, Gesina Van Lijnschoten, Sietske Corporaal, Judith Nieken, Peter D. Siersema, Tanya M. Bisseling, Rachel S. Van Der Post, Rutger Quispel, Arjan Van Tilburg, Liekele E. Oostenbrug, Robert G. Riedl, Lieke Hol, Mike Kliffen, Suzan Nikkessen, Ben M. Eyck, J. Jan B. Van Lanschot, Michael DoukasManon C.W. Spaander*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Active surveillance after neoadjuvant treatment is increasingly implemented. The success of this strategy relies on the accurate detection of residual cancer. This study aimed to assess the diagnostic value of a second (bite-on-bite) biopsy for the detection of residual esophageal cancer and to correlate outcomes to the distribution of residual cancer found in the resection specimen. Methods A multicenter prospective study of esophageal cancer patients undergoing active surveillance after neoadjuvant chemoradiotherapy was performed. At clinical response evaluations, an upper gastrointestinal (GI) endoscopy was performed with at least four bite-on-bite biopsies of the primary tumor site. First and second biopsies were analyzed separately. Patients with histopathological evidence of residual cancer were included in the primary analysis. Two pathologists blinded for biopsy outcome examined all resection specimens. Results Between October 2017 and July 2020, 626 upper GI endoscopies were performed in 367 patients. Of 138 patients with residual cancer, 112 patients (81%) had at least one positive biopsy. In 14 patients (10 %) only the first biopsy was positive and in 25 patients (18%) only the second biopsy (P = 0.11). Remarkably, the rates of patients with tumor- free mucosa and deeper located tumors were higher in patients detected by the first biopsy. The second biopsy increased the false-positive rate by 3 percentage points. No adverse events occurred. Conclusions A second (bite-on-bite) biopsy improves the detection of residual esophageal cancer by almost 20 percentage points, at the expense of increasing the false-positive rate by 3 percentage points. The higher detection rate is explained by the higher number of biopsies obtained rather than by the penetration depth.

Original languageEnglish
Pages (from-to)1131-1138
Number of pages8
Issue number12
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
P.D. Siersema has received research support from Pentax, The E-Nose Company, MicroTech, and Motus GI, and consultation fees from Boston Scientific and Motus GI. J.J.B van Lanschot has received research support from the Dutch Cancer Society and ZonMW. The remaining authors declare that they have no conflict of interest.

Publisher Copyright: © 2022. Thieme. All rights reserved.


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