TY - JOUR
T1 - Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy
AU - Van Der Bogt, Ruben D.
AU - Van Der Wilk, Berend J.
AU - Oudijk, Lindsey
AU - Schoon, Erik J.
AU - Van Lijnschoten, Gesina
AU - Corporaal, Sietske
AU - Nieken, Judith
AU - Siersema, Peter D.
AU - Bisseling, Tanya M.
AU - Van Der Post, Rachel S.
AU - Quispel, Rutger
AU - Van Tilburg, Arjan
AU - Oostenbrug, Liekele E.
AU - Riedl, Robert G.
AU - Hol, Lieke
AU - Kliffen, Mike
AU - Nikkessen, Suzan
AU - Eyck, Ben M.
AU - Van Lanschot, J. Jan B.
AU - Doukas, Michael
AU - Spaander, Manon C.W.
N1 - 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.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85131808135&partnerID=8YFLogxK
U2 - 10.1055/a-1846-1025
DO - 10.1055/a-1846-1025
M3 - Article
C2 - 35668664
AN - SCOPUS:85131808135
SN - 0013-726X
VL - 54
SP - 1131
EP - 1138
JO - Endoscopy
JF - Endoscopy
IS - 12
ER -
