Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy

Ruben D van der Bogt; Berend J van der Wilk; Lindsey Oudijk; Erik J Schoon; Gesina van Lijnschoten; Sietske Corporaal; Judith Nieken; Peter D Siersema; Tanya M Bisseling; Rachel S van der Post; Rutger Quispel; Arjan van Tilburg; Liekele E Oostenbrug; Robert G Riedl; Lieke Hol; Mike Kliffen; Suzan Nikkessen; Ben M Eyck; J Jan B van Lanschot; Michael Doukas; Manon C W Spaander

doi:10.1055/a-1846-1025

Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy

Ruben D van der Bogt, Berend J van der Wilk, Lindsey Oudijk, Erik J Schoon, Gesina van Lijnschoten, Sietske Corporaal, Judith Nieken, Peter D Siersema, Tanya M Bisseling, Rachel S van der Post, Rutger Quispel, Arjan van Tilburg, Liekele E Oostenbrug, Robert G Riedl, Lieke Hol, Mike Kliffen, Suzan Nikkessen, Ben M Eyck, J Jan B van Lanschot, Michael DoukasManon C W Spaander^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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 (P = 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.

CONCLUSIONS: 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.

Original language	English
Pages (from-to)	1131-1138
Number of pages	8
Journal	Endoscopy
Volume	54
Issue number	12
DOIs	https://doi.org/10.1055/a-1846-1025
Publication status	Published - 3 Jun 2022

Keywords

CARCINOMA
ENDOSCOPY

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10.1055/a-1846-1025

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Cite this

van der Bogt, R. D., van der Wilk, B. J., Oudijk, L., Schoon, E. J., van Lijnschoten, G., Corporaal, S., Nieken, J., Siersema, P. D., Bisseling, T. M., van der Post, R. S., Quispel, R., van Tilburg, A., Oostenbrug, L. E., Riedl, R. G., Hol, L., Kliffen, M., Nikkessen, S., Eyck, B. M., van Lanschot, J. J. B., ... Spaander, M. C. W. (2022). Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy. Endoscopy, 54(12), 1131-1138. https://doi.org/10.1055/a-1846-1025

@article{d8e98dfb8b9e45daad982e6fe0f03ec0,

title = "Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy",

abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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 (P = 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.CONCLUSIONS: 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.",

keywords = "CARCINOMA, ENDOSCOPY",

author = "{van der Bogt}, {Ruben D} and {van der Wilk}, {Berend J} and Lindsey Oudijk and Schoon, {Erik J} and {van Lijnschoten}, Gesina and Sietske Corporaal and Judith Nieken and Siersema, {Peter D} and Bisseling, {Tanya M} and {van der Post}, {Rachel S} and Rutger Quispel and {van Tilburg}, Arjan and Oostenbrug, {Liekele E} and Riedl, {Robert G} and Lieke Hol and Mike Kliffen and Suzan Nikkessen and Eyck, {Ben M} and {van Lanschot}, {J Jan B} and Michael Doukas and Spaander, {Manon C W}",

year = "2022",

month = jun,

day = "3",

doi = "10.1055/a-1846-1025",

language = "English",

volume = "54",

pages = "1131--1138",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "12",

}

van der Bogt, RD, van der Wilk, BJ, Oudijk, L, Schoon, EJ, van Lijnschoten, G, Corporaal, S, Nieken, J, Siersema, PD, Bisseling, TM, van der Post, RS, Quispel, R, van Tilburg, A, Oostenbrug, LE, Riedl, RG, Hol, L, Kliffen, M, Nikkessen, S, Eyck, BM, van Lanschot, JJB, Doukas, M & Spaander, MCW 2022, 'Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy', Endoscopy, vol. 54, no. 12, pp. 1131-1138. https://doi.org/10.1055/a-1846-1025

TY - JOUR

T1 - Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy

AU - van der Bogt, Ruben D

AU - van der Wilk, Berend J

AU - Oudijk, Lindsey

AU - Schoon, Erik J

AU - van Lijnschoten, Gesina

AU - Corporaal, Sietske

AU - Nieken, Judith

AU - Siersema, Peter D

AU - Bisseling, Tanya M

AU - van der Post, Rachel S

AU - Quispel, Rutger

AU - van Tilburg, Arjan

AU - Oostenbrug, Liekele E

AU - Riedl, Robert G

AU - Hol, Lieke

AU - Kliffen, Mike

AU - Nikkessen, Suzan

AU - Eyck, Ben M

AU - van Lanschot, J Jan B

AU - Doukas, Michael

AU - Spaander, Manon C W

PY - 2022/6/3

Y1 - 2022/6/3

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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 (P = 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.CONCLUSIONS: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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 (P = 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.CONCLUSIONS: 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.

KW - CARCINOMA

KW - ENDOSCOPY

U2 - 10.1055/a-1846-1025

DO - 10.1055/a-1846-1025

M3 - Article

C2 - 35668664

SN - 0013-726X

VL - 54

SP - 1131

EP - 1138

JO - Endoscopy

JF - Endoscopy

IS - 12

ER -