Comparison of Biomarker Expressivity in the Esophageal Metaplasia-Dysplasia-Adenocarcinoma Sequence

Résumé fourni par la source

Esophageal adenocarcinoma is among the most lethal cancers worldwide, with a 5-year survival rate of 5%. Diagnosis of small mucosal biopsies often presents a challenge for even experienced pathologists with extensive training. A number of immunohistochemical (IHC) stains have been studied by others in the hopes of providing “objective” evidence supporting one diagnosis or another. Our study examines the utility of three IHC stains, cyclin D1, p53, and HER2, as potential aids in distinguishing low-risk histopathologic changes—BE with or without low-grade dysplasia (conditions requiring only active surveillance) from BE with high-grade dysplasia and esophageal adenocarcinoma (conditions requiring surgical intervention) on small mucosal biopsy specimens. A total of 104 cases of paraffin-embedded archival specimens of BE only (n = 41), BE with low-grade dysplasia (n = 18), BE with high-grade dysplasia (n = 24), and esophageal adenocarcinoma (n = 21) previously diagnosed in the Department of Pathology at Danbury Hospital were used to prepare tissue microarrays (TMAs). These TMA blocks were cut and stained with H&E stain and each of the three IHC stains mentioned above. Diffuse, strong staining (3+) for cyclin D1 and HER2 was only observed in high-grade esophageal dysplasia and invasive adenocarcinoma, whereas BE with or without low-grade dysplasia showed only mild (1+) or intermediate (2+) intensity staining. All biopsy tissues with BE had normal p53 staining pattern, but p53 did not show any difference in staining tissues with low- and high-grade dysplasia or invasive adenocarcinoma. Both cyclin D1 and HER2 IHC stains show promising results in distinguishing low- and high-risk lesions on biopsies from patients with BE and may aid in enhancing the reliability of histologic diagnoses. However, the relative infrequency of 3+ positive staining may limit clinical utility, since the absence of 3+ staining does not exclude a high-risk lesion.

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