Clin Endosc.  2025 Jan;58(1):85-93. 10.5946/ce.2024.068.

Factors influencing lateral margin diagnosis challenges in Barrett’s esophageal cancer: a bicenter retrospective study in Japan

• Tanaka I
• Unno S
• Yamamoto K
• Nawata Y
• Igarashi K
• Matsuda T
• Hirasawa D

• KMID: 2564022
• DOI: http://doi.org/10.5946/ce.2024.068

Abstract

Background/Aims
We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation.
Methods
We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE).
Results
We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively).
Conclusions
LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

Keyword

Barrett’s esophageal cancer; Lateral margin

Figure

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  Fig. 1. Flow diagram of the patient enrollment process. ER, endoscopic resection; BEA, Barrett’s esophageal adenocarcinoma.

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  Fig. 2. (A) Endoscopic image of Barrett’s esophageal adenocarcinoma (BEA) in the clear demarcation group. (B) Magnifying endoscopy with narrow-band imaging show clear demarcation of the lesion. (C) Endoscopic image of BEA in the unclear demarcation group. (D) Magnifying endoscopy with narrow-band imaging show mild irregularity of the lesion and unclear demarcation of the lesion.

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  Fig. 3. Evaluation of the pathological structures. (A) A representative slide displaying the demarcation of the lesion. Black arrow indicates the demarcation between cancerous and non-cancerous area (hematoxylin and eosin stain, ×40). (B) This figure specifically illustrates the length and width of foveolar structures and the width of marginal crypt epithelium.

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  Fig. 4. A representative case from the unclear demarcation group. (A) The reddish depressed lesion are seen at the anterior side of the esophagogastric junction. (B) Magnifying endoscopy with narrow-band imaging show mild irregular mucosal pattern, and the demarcation of the lesion is unclear. However, there is a distinct difference in the width of marginal crypt epithelium (MCE) between the mucosa on the upper and lower part of this image; the MCE appears narrower on the upper part and wider on the lower, which corresponds to the cancerous mucosa and non-cancerous mucosa, respectively. (C) Pathological findings reveal significant difference in the width of MCE between cancerous and non-cancerous area. Black arrows indicate the edge of MCE, and thus the area sandwiched by black arrows shows the width of MCE.

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  Fig. 5. Newly proposed magnified endoscopic classification of Barrett's esophageal neoplasms, incorporating the results of this study. GTV, green thick vessels; m-FP, modified flat pattern; MCE, marginal crypt epithelium.

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