van der Bogt Ruben D, van der Wilk Berend J, Oudijk Lindsey, Schoon Erik J, van Lijnschoten Gesina, Corporaal Sietske, Nieken Judith, Siersema Peter D, Bisseling Tanya M, van der Post Rachel S, Quispel Rutger, van Tilburg Arjan, Oostenbrug Liekele E, Riedl Robert G, Hol Lieke, Kliffen Mike, Nikkessen Suzan, Eyck Ben M, van Lanschot J Jan B, Doukas Michael, Spaander Manon C W
Department of Gastroenterology and Hepatology, Erasmus Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Surgery, Erasmus Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Endoscopy. 2022 Dec;54(12):1131-1138. doi: 10.1055/a-1846-1025. Epub 2022 Jun 3.
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.
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.
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 ( = 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.
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.
新辅助治疗后进行主动监测的情况越来越普遍。该策略的成功依赖于对残留癌症的准确检测。本研究旨在评估二次（逐块）活检对检测残留食管癌的诊断价值，并将结果与手术切除标本中残留癌症的分布相关联。
对新辅助放化疗后接受主动监测的食管癌患者进行了一项多中心前瞻性研究。在临床反应评估时，进行上消化道（GI）内镜检查，并对原发肿瘤部位至少进行四次逐块活检。第一次和第二次活检分别进行分析。有残留癌组织病理学证据的患者纳入初步分析。两名对活检结果不知情的病理学家检查了所有手术切除标本。
2017年10月至2020年7月期间，对367例患者进行了626次上消化道内镜检查。在138例有残留癌的患者中，112例（81%）至少有一次活检呈阳性。14例（10%）仅第一次活检呈阳性，25例（18%）仅第二次活检呈阳性（P = 0.11）。值得注意的是，第一次活检检测出的患者中无肿瘤黏膜和肿瘤位置更深的患者比例更高。第二次活检使假阳性率提高了3个百分点。未发生不良事件。
二次（逐块）活检可使残留食管癌检测率提高近20个百分点，但代价是假阳性率提高3个百分点。检测率的提高是由于获取的活检数量增加，而非穿刺深度增加所致。
