Objective
Barrett’s esophagus (BE) is an established precursor to esophageal
adenocarcinoma, which has a poor prognosis unless detected at an early stage.
The progression of BE to adenocarcinoma is slow and unpredictable. Currently, the
best predictor of adenocarcinoma is histological detection of dysplasia.
Accurate grading of dysplasia and especially discriminating low-grade dysplasia
LGD from high-grade dysplasia HGD is important for management. Marked
variability exists when diagnosing dysplasia in BE. This highlights the need for a
diagnostic adjunct, especially in histologically challenging cases.
This study aims at evaluating the role of immunohistochemical expression of (p53,
IMP3, AMCAR and CDx2) in Barrett’s oesophagus spectrum, to increase the
diagnostic accuracy of grading dysplasia and predicting progression risk.
Methods
This is a retrospective immunohistochemical study, performed on selected 52
cases of esophageal biopsies.
Results
The p53 was negative in nondysplastic Barrett’s esophagus (ND-BE) and LGD
and strong positivity towards HGD/esophageal adenocarcinoma (EAC). CDX2
showed highest expression among ND-BE and decreased towards EAD. IMP3 and
AMCAR were negative in all cases of ND-BE with gradual increase among HGD/
esophageal adenocarcinoma cases.
IMP3, AMCAR, and CDX2 were found to be more sensitive in detecting HGD (80%,
70% & 70%). Meanwhile, p53 is more specific (100%), IMP3 and AMCAR are more
sensitive discriminating LGD from HGD (80%) than p53 and CDX2 (60%, 70%).
Conclusion
This combined panel of p53, CDX2, IMP3, and AMACR could be used in
conjunction with histology as a promising tool to accurately predict progression
form BE to HGD/adenocarcinoma with a great value for early detecting high grade
dysplasia, discriminating it from LGD, improving risk stratification in BE, and
optimizing patient care.