Barrett-Neoplasie: Wo liegt eigentlich das Problem?

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die Barrett-Schleimhaut ist charakterisiert durch einen metaplastischen Schleimhautersatz des Plattenepithels im distalen Ösophagus durch Zylinderepithel und geht mit einem erhöhten Risiko einer Karzinomentstehung einher. Bis heute gibt es keine weltweit einheitliche Definition der Erkrankung. Ebenso uneinheitlich ist die Abgrenzung einer niedriggradigen Dysplasie/intraepithelialen Neoplasie von einer hochgradigen Dysplasie/intraepithelialen Neoplasie. Die vorliegende Arbeit versucht, aus morphologischer Sicht Hilfestellungen für eine einheitliche und korrekte Diagnosestellung zu geben, diskutiert die Möglichkeiten der endoskopischen Diagnostik und beschreibt die aktuellen Biomarker der Barrett-Schleimhaut.

Abstract

The Barrett mucosa is characterised by metaplastic transformation in the distal oesophagus from squamous epithelium into columnar-lined cells and shows an increased risk for progression into adenocarcinoma. Up to date an international definition of Barrettʼs oesophagus is still lacking and it is also difficult to separate low-grade dysplasia/intraepithelial neoplasia from high-grade dysplasia/intraepithelial neoplasia. The present review describes the criteria for the histological diagnosis, discusses the possibilities of endoscopic diagnosis and highlights the biomarkers of the Barrett mucosa.

• Literatur

• 1 Kadri SR, Lao-Sirieix P, OʼDonovan M et al. Acceptability and accuracy of a non-endoscopic screening test for Barrettʼs oesophagus in primary care: cohort study. BMJ 2010; 341: c4372-c4380
  CrossrefPubMedGoogle Scholar
• 2 Fitzgerald RC, di Pietro M, Ragunath K et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrettʼs esophagus. Gut 2014; 63: 7-42
  CrossrefPubMedGoogle Scholar
• 3 Takubo K, Aida J, Naomoto Y et al. Cardiac rather than intestinal-type background in endoscopic resection specimens of minute Barrett adenocarcinoma. Hum Pathol 2009; 40: 65-74
  CrossrefPubMedGoogle Scholar
• 4 van Sandick JW, Baak JP, van Lanschot JJ et al. Computerized quantitative pathology for the grading of dysplasia in surveillance biopsies of Barrettʼs oesophagus. J Pathol 2000; 190: 177-183
  CrossrefPubMedGoogle Scholar
• 5 Clark GW, Smyrk TC, Burdile P et al. Is Barrettʼs metaplasia the source of adenocarcinoma oft he cardia?. Arch Surg 1994; 129: 609-615
  CrossrefPubMedGoogle Scholar
• 6 Cameron AJ, Lomboy CT, Pera M et al. Adenocarcinoma of the esophagogastric junction and Barrettʼs esophagus. Gastroenterology 1995; 109: 1541-1546
  CrossrefPubMedGoogle Scholar
• 7 Ruol A, Parenti A, Zaninotto G et al. Intestinal metaplasia ist he probable common precursor of adenocarcinoma in Barrettʼs esophagus and adenoocarcinoma oft he gastric cardia. Cancer 2000; 88: 2520-2528
  CrossrefPubMedGoogle Scholar
• 8 Cameron AJ, Arora AS. Barrettʼs esophagus and reflux esophagitis: is there a missing link?. Am J Gastroenterol 2002; 97: 273-278
  CrossrefPubMedGoogle Scholar
• 9 Tsuji N, Ishiguro S, Tsukamato Y et al. Mucin phenotypic expression and background mucosa of esophagogastric junctional adenocarcinoma. Gastric Cancer 2004; 7: 97-103
  PubMedGoogle Scholar
• 10 Nunobe S, Nakanishi S, Taniguchi H et al. Two distinct pathways of tumorigenesis of adenocarcinomas oft he esophagogastric junction, related or unrelated to intestinal metaplasia. Pathol Int 2007; 57: 315-321
  CrossrefPubMedGoogle Scholar
• 11 Faller G, Stolte M. Barrettʼs oesophagus: time for consensus. Virchows Arch 2003; 443: 595-596
  CrossrefPubMedGoogle Scholar
• 12 Vieth M, Langner C, Neumann H et al. Barrettʼs esophagus. Practical issues for daily routine diagnosis. Pathol Res Pract 2012; 208: 261-268
  CrossrefPubMedGoogle Scholar
• 13 Liu W, Hahn H, Odze RD et al. Metaplastic esophageal columnar epithelium without goblet cells shows DNA content abnormalities similar to goblet cell-containing epithelium. Am J Gastroenterol 2009; 104: 816-824
  CrossrefPubMedGoogle Scholar
• 14 Vieth M, Barr H. Editorial: Defining a bad Barrettʼs segment: is it dependent on goblet cells?. Am J Gastroenterol 2009; 104: 825-827
  CrossrefPubMedGoogle Scholar
• 15 Vieth M, Schubert B, Lang-Schwarz C et al. Frequency of Barrettʼs neoplasia after initial negative endoscopy with biopsy: a long-term histopathological follow-up study. Endoscopy 2006; 38: 1201-1205
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Faller G, Borchard F, Ell C et al. Working Group for Gastroenterological Pathology of the German Society for Pathology. Histopathological diagnosis of Barrettʼs mucosa and associated neoplasias: results of a consensus conference of the Working Group for Gastroenterological Pathology of the German Society for Pathology on 22 September 2001 in Erlangen. Virchows Arch 2003; 443: 597-601
  CrossrefPubMedGoogle Scholar
• 17 Vakil N, van Zanten SV, Kahrilas P et al. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920
  CrossrefPubMedGoogle Scholar
• 18 Sharma P, Dent J, Armstrong D et al. The development and validation of an endoscopic grading system for Barrettʼs esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
  CrossrefPubMedGoogle Scholar
• 19 Spechler SJ, Sharma P, Souza RF et al. American Gastroenterological Association. American Gastroenterological Association technical review on the management of Barrettʼs esophagus. Gastroenterology 2011; 140: e18-e52
  PubMedGoogle Scholar
• 20 Neumann H, Langner C, Neurath MF et al. Confocal laser endomicroscopy for diagnosis of Barrettʼs esophagus. Front Oncol 2012; 2: 42
  PubMedGoogle Scholar
• 21 Krompecher E. Basalzellen, Metaplasie und Regeneration. Beitr z path Anat u z allg Path 1923; 72: 163-182
  PubMedGoogle Scholar
• 22 Riddell RH. Grading of dysplasia. Eur J Cancer 1995; 31A: 1169-1178
  PubMedGoogle Scholar
• 23 Odze RD, Flejou JF, Bofetta P et al. Adenocarcinoma of the oesophagogastric junction. In: Bosman FT, Carneiro F, Hruban RH et al. WHO classification of tumours of the digestive system. 4th ed. Lyon: 2010: 39-45
  Google Scholar
• 24 Wang KK, Sampliner RE. Practice Parameterʼs Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barretts esophagus. Am J Gastroenterol 2008; 103: 788-797
  CrossrefPubMedGoogle Scholar
• 25 Montgomery E, Bronner MP, Goldblum JR et al. Reproducibility of the diagnosis of dysplasia in Barrettʼs oesophagus: a reaffirmation. Hum Pathol 2001; 32: 368-378
  CrossrefPubMedGoogle Scholar
• 26 Mueller J, Werner M, Stolte M. Barrettʼs esophagus: histopathologic definitions and diagnostic criteria. World J Surg 2004; 28: 148-154
  CrossrefPubMedGoogle Scholar
• 27 Curvers WL, Singh R, Wallace MB et al. Identification of predictive factors for early neoplasia in Barrettʼs esophagus after autofluorescence imaging: a stepwise multicenter structured assessment. Gastrointest Endosc 2009; 70: 9-17
  CrossrefPubMedGoogle Scholar
• 28 Munding J, Ziebarth W, Belyaev O et al. [Histological classification: evaluation of resection specimens of EMR/ESD–response evaluation after neoadjuvant therapy]. Zentralbl Chir 2013; 138 (Suppl. 02) e55-e62
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 OʼConnor JB, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrettʼs esophagus: report on the Cleveland clinics Barrettʼs esophagus registry adenocarcinoma and dyplasia in Barrettʼs esophagus. Am J Gastroenterol 1999; 94: 2037-2042
  PubMedGoogle Scholar
• 30 Skacel MS, Petras RE, Gramlich TL et al. The diagnosis of low-grade dysplasia in Barrettʼs esophagus and ist implications for disease progression diagnosis of dysplasia in Barrettʼs esophagus. Am J Gastroenterol 2000; 95: 3383-3387
  CrossrefPubMedGoogle Scholar
• 31 Schnell TG, Sontag SJ, Chejfec G et al. Long-term nonsurgical management of Barrettʼs esophagus with high-grade dysplasia. Long-term nonsurgical management of Barrettʼs esophagus with high-grade dysplasia. Gastroenterology 2001; 120: 1607-1619
  CrossrefPubMedGoogle Scholar
• 32 Weston AP, Badr AS, Hassanein RS. Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive oft he developement of Barrettʼs multifocal high grade dysplasia or adenocarcinoma. Am J Gastroenterol 1999; 94: 3413-3419
  CrossrefPubMedGoogle Scholar
• 33 Conio M, Blanchi S, Lapertosa G et al. Long-term endoscopic surveillance of patients with Barrettʼs esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study surveillance of Barrettʼs esophagus: a prospective study. Am J Gastroenterol 2003; 98: 1931-1939
  CrossrefPubMedGoogle Scholar
• 34 Sharma P, Sampliner RE. Barrett esophagus. Curr Opin Gastroenterol 2002; 18: 471-478
  CrossrefPubMedGoogle Scholar
• 35 Curvers WL, ten Kate FJ, Krishnadath KK et al. Low-grade dysplasia in Barrettʼs esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010; 105: 1523-1530
  CrossrefPubMedGoogle Scholar
• 36 Dulai GS, Shekelle PG, Jensen DM et al. Dysplasia and risk of further neoplasticprogression in a regional veterans administration Barrettʼs cohort. Am J Gastroenterol 2005; 100: 775-783
  CrossrefPubMedGoogle Scholar
• 37 Srivastava A, Hornick JL, Li X et al. Extent of low-grade dysplasia is a risk factor for the developement of esophageal adenocarcinoma in Barrettʼs esophagus. Am J Gastroenterol 2007; 102: 483-493
  CrossrefPubMedGoogle Scholar
• 38 Lim CH, Treanor D, Dixon MF et al. Low-grade dysplasia in Barrettʼs esophagus has a high risk of progression. Endoscopy 2007; 39: 581-587
  Article in Thieme ConnectPubMedGoogle Scholar
• 39 Buttar NS, Wang KK. Mechanisms of disease: Carcinogenesis in Barrettʼs esophagus. Nat Clin Pract Gastroenterol Hepatol 2004; 1: 106-112
  CrossrefPubMedGoogle Scholar
• 40 Kaye PV, Haider SA, Ilyas M et al. Barrettʼs dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p 53 immunohistochemistry. Histopathology 2009; 54: 699-712
  CrossrefPubMedGoogle Scholar
• 41 Weston AP, Sharma P, Topalovski M et al. Long-term follow-up of Barrettʼs high grade dysplasia. Am J Gastroenterol 2000; 95: 1888-1893
  CrossrefPubMedGoogle Scholar
• 42 Reid BJ, Levine DS, Longton G et al. Predictors of progression to cancer in Barrettʼs esophagus: baseline histology and flow cytometry identify low- and high risk patient subsets. Am J Gastroenterol 2000; 95: 1669-1676
  PubMedGoogle Scholar
• 43 Downs-Kelly E, Mendelin JE, Bennett AE et al. Poor interobserver agreement in the distinction of high-grade dysplasia and adenocarcinoma in pretreatment Barrettʼs esophagus biopsies. Am J Gastroenterol 2008; 103: 2333-2340
  CrossrefPubMedGoogle Scholar
• 44 van Dekken H, Hop WC, Tilanus HW et al. Immunohistochemical evaluation of a panel of tumor cell markers during malignant progression in Barrett esophagus. Am J Clin Pathol 2008; 130: 745-753
  CrossrefPubMedGoogle Scholar
• 45 Dorer R, Odze RD. AMACR immunostaining is useful in detecting dysplastic epithelium in Barrettʼs esophagus, ulcerative colitis, and Crohnʼs disease. Am J Surg Pathol 2006; 30: 871-877
  CrossrefPubMedGoogle Scholar
• 46 Shy XY, Bharwandeen B, Leong AS. p 16, cyclin D1, Ki67, and AMACR as markers for dysplasia in Barrett esophagus. Appl Immunohistochem Mol Morph 2008; 16: 447-452
  CrossrefPubMedGoogle Scholar
• 47 Rabinovitch PS, Longton G, Blount PL et al. Aneuploidy and high expression of p 53 and Ki67 is associated with neoplastic progression Barrett esophagus. Cancer Biomark 2008; 4: 1-10
  PubMedGoogle Scholar
• 48 Reid BJ, Prevo LJ, Galipeau PC et al. Predictors of progression in Barrettʼs esophagus II: baseline 17 p (p 53) loss of heterozygosity identified a patient subset at increased risk for neoplastic progression. Am J Gastroenterol 2001; 96: 2839-2848
  CrossrefPubMedGoogle Scholar
• 49 Rygiel AM, Milano F, Ten Kate FJ et al. Assessment of chromosomal gains as compared to DNA content changes is more useful to detect dysplasia in Barrettʼs esophagus brush cytology specimens. Genes Chromosomes Cancer 2008; 47: 396-404
  CrossrefPubMedGoogle Scholar
• 50 Bird-Lieberman EL, Dunn JM, Coleman HG et al. Population-based study reveals new risk-stratification biomarker panel for Barrettʼs esophagus. Gastroenterology 2012; 143: 927-935
  CrossrefPubMedGoogle Scholar