223 Evaluation of Post-Transoral Endoscopic Circumferential Resection Esophageal Biopsies With p53 Staining. (11th January 2018)

• Record Type: Journal Article
• Authors: DiCarlo, Christina; Lloyd, Emily; Kosovec, Juliann; Zaidi, Ali; Jobe, Blair; Silverman, Jan
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S95
• Page End: S95
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx123.222
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: Transoral endoscopic circumferential resection (TECR) with extracellular matrix (ECM) placement is a procedure unique to our institution that is a less invasive treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD) and early adenocarcinoma (EAC). This endoscopic procedure involves circumferential en bloc removal of the affected mucosa and submucosa with subsequent placement of an ECM to prevent stricture formation and promote healing. The aim of this study is to identify abnormal p53 IHC staining within any residual glandular mucosa within the site of TECR. Methods: Post-TECR/ECM biopsies containing glandular-type mucosa in the resection bed and adjacent esophagus were selected for p53 staining, excluding cases with HGD or EAC. P53 staining was assessed as patchy weak nuclear staining (normal), intense nuclear staining (abnormal) or complete loss of staining (abnormal). p53 staining was correlated to histologic findings of benign glandular mucosa, intestinal metaplasia (IM), and low-grade dysplasia (LGD), or indefinite for dysplasia (IFD). Results: A total of 21 post-TECR/ECM biopsies were evaluated from five patients. p53 staining was interpreted as follows: 11 normal (52.4%) and 10 abnormal (47.6%). Within the abnormal group, all cases contained complete loss of p53 staining. IM was present in three biopsies (14.2%), and IFD was found in one biopsy (4.8%). Only one of the cases with abnormal p53 staining contained IM, while none had dysplasia. The majority of cases (90%) with abnormal p53 staining correlated to normal/reactive histology. Likewise, two of three cases with IM and IFD displayed normal p53 staining patterns. Conclusion: IHC staining for p53 may be helpful as an adjunct in the surveillance of TECR patients. We demonstrated that abnormal p53 staining could be found in normal/reactive glandular mucosa. The significance of this finding is uncertain, but may indicate the need for closer follow-up in this unique group of patients.