Discrepancies Between Endoscopic and Histopathologic Size Assessment of Early Barrett's Esophageal Adenocarcinoma in Endoscopic Submucosal Dissection

Aims this study aimed to compare contemporary assessments of early Barrett's esophageal adenocarcinoma size by endoscopic estimation and histopathology measurement and to determine the impact of endoscopic tumor mis-sizing on the choice of the resection method [1] [2].

Methods 40 cases of cancers resected en bloc by endoscopic submucosal dissection between 2018 and 2023, with available endoscopic, macro- (fixed), and micro histopathologic (tumor extension) size assessment (75% men, mean age 70.4 years). Endoscopic size estimates of tumors were compared with post fixation histopathologic tumor measurements. Size variation was defined as (endoscopic estimate−histopathologic size)/ (histopathologic size). Clinical mis-sizing was defined as a size variation of>33%. Main outcome was the percentage of clinical mis-sizing between endoscopic and macro-histopathology size, secondary outcomes mean size variation and percentage of mis-sizing compared with the micro-histopathology size and percentage of inappropriate resection technique recommendation due to size variation.

Results Of the 40 cases, 20 (50%) had stage T1a and 20 T1b (50%). The mean size of tumors measured were endoscopic 16.7±6.3 (mm) and fixed macro-histopathologic 21.5±11.8 (mm). The mean size variation between the tumor endoscopic size estimation and the macro-histopathologic size was -4.8±11.2 (mm) and mean size variation percentage of -4.1±53.2 (%). 45% of included tumors had clinical mis-sizing. In 19 patients, the endoscopic measurement was≥20 mm in tumors that were found to be<20 mm in 5 (26.3%) on histopathologic measurement. The mean size variation between macro- vs. micro-histopathologic was 0.7±12.9 (mm) with 55% mis-sizing.

Conclusions There is marked variation between endoscopic and histopathologic size measurement of early Barrett's esophageal adenocarcinoma,and this can lead to inappropriate recommendations of the resection method because of clinical mis-sizing. Other endoscopic size measurement methods have to be developed to help with decision making for the appropriate resection technique.

Publication History

Article published online:
27 March 2025

• References

• 1 Takeshi Onda, et al. Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection. World J Gastrointest Endosc 2024; 16 (3): 136-147
• 2 Eichenseer PJ. et al. Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum 2013; 56 (3): 315-21