‘Missed’ oesophageal adenocarcinoma and high grade dysplasia in Barrett’s oesophagus patients: a large population-based study

Authors

van Putten M, Johnston BT, Murray LJ, Gavin AT, McManus DT, Bhat S, Turkington RC, Coleman HG.

Departments / Institutions

a Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, the Netherlands. b Department of Gastroenterology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland. c Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland d Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland e Department of Pathology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland. f Department of Gastroenterology, Craigavon Area Hospital, Southern Health and Social Care Trust, Belfast, Northern Ireland. g Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland

Publication Date

Autumn 2016

Aims

A recent systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) developing in Barrett’s oesophagus (BO) patients are ‘missed’ at index endoscopy, however more population-based data are needed.

Methods

A recent systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) developing in Barrett’s oesophagus (BO) patients are ‘missed’ at index endoscopy, however more Patients from the Northern Ireland BO register diagnosed between 1993-2010 were selected (n=13,159). Linkage to the Northern Ireland Cancer Registry identified patients who developed OAC or high-grade dysplasia (HGD) by end 2013. The main outcome was the proportion of HGD/OAC diagnosed within 3-12 months following BO diagnosis (potential ‘missed’ cases). Logistic regression analysis compared characteristics of ‘missed’ versus ‘incident’ HGD/OAC occurring after one year after incident BO.population-based data are needed.

Results

There were 267 patients diagnosed with HGD/OAC at least three months after BO diagnosis, of which 34 patients (12.7%) were potential ‘missed’ cases. The proportion of ‘missed’ HGD/OAC increased to 25% within patients with lowgrade dysplasia (LGD) compared to 9% of non-dysplastic BO patients. Older age carried a higher risk of ‘missed’ compared with incident HGD/OAC. Non-dysplastic BO patients were more likely to be detected with a ‘missed’ OAC (rather than HGD), compared with BO-LGD patients (89 v. 40% of ‘missed’ progression detected as OAC, respectively).

Conclusion

HGD/OAC may be ‘missed’ at index BO endoscopy in up to 13% of BO patients and 9% of non-dysplastic BO patients who progressed to HGD/OAC, which is significant but substantially lower than previously reported estimates. Higher rates of ‘missed’ HGD/OAC in LGD-BO likely reflect appropriate surveillance. Increased awareness, adequate biopsy sampling and identifying biomarkers may reduce the number of ‘missed’ cases.