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Intraepitheliale Neoplasie des Barrett-Ösophagus

Vorhersage des malignen Potenzials

Intraepithelial neoplasia of Barrett’s esophagus

Prognosis of potential malignancy

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Zusammenfassung

Adenokarzinome im distalen Ösophagus entstehen mehrheitlich aus einer intestinalen Metaplasie (Barrett-Ösophagus) über die Zwischenstufen einer niedrig- und hochgradigen intraepithelialen Neoplasie. Für die Abschätzung des Karzinomrisikos eines Patienten mit Barrett-Ösophagus ist die histologische Untersuchung endoskopisch entnommener Biopsien der Goldstandard. Biomarker, die in prospektiven Verlaufsstudien (Biomarker-Phase IV-Studien) einen prädiktiven Wert gezeigt haben, sind u. a. Allelverluste von TP53, die Bestimmung der Tetraploidie- bzw. Aneuploidierate oder die Cyclin-D1-Expression. Erfolgversprechende Biomarker aus retrospektiven Biomarker-Phase-III-Studien sind etwa Polysomien, spezifische DNA-Zugewinne und -Verluste, die Proliferationsrate (Mib-1) oder Methylierungsmarker. Da diese Untersuchungen sehr aufwendig sind und die Daten bislang nicht ausreichend bestätigt werden konnten, ist ihr Einsatz in der Routinediagnostik nicht empfehlenswert. Die Anwendung einiger immunhistochemischer Marker für die Klassifikation der intraepithelialen Neoplasie in schwierigen Einzelfällen kann dagegen sinnvoll sein.

Abstract

Adenocarcinomas of the distal esophagus mainly develop from intestinal metaplasia (Barrett’s esophagus) through intermediate steps of low-grade and high-grade intraepithelial neoplasia. Histopathological examination of endoscopic biopsies constitutes the gold standard for estimating the cancer risk of a patient with Barrett’s esophagus. Several prospective biomarker phase IV studies have demonstrated the predictive value of e.g. allelic loss of TP53, tetraploidy and aneuploidy as well as cyclin D1 expression. Among the relevant biomarkers from retrospective phase III studies are polysomy and specific DNA gains and losses, markers of proliferation (Mib-1) and methylation markers. As there are conflicting results in the literature and these analyses are costly, their use in routine patient care cannot yet be recommended. However, immunostaining for several markers may assist in the classification of intraepithelial neoplasia in individual difficult cases.

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  1. Institut für Pathologie, Ludwig-Aschoff-Haus, Universitätsklinikum Freiburg, Breisacher Str. 115a, 79106, Freiburg, Deutschland

    M. Werner & S. Laßmann

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  1. M. Werner
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  2. S. Laßmann
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Correspondence to M. Werner.

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Werner, M., Laßmann, S. Intraepitheliale Neoplasie des Barrett-Ösophagus. Pathologe 32 (Suppl 2), 197 (2011). https://doi.org/10.1007/s00292-011-1493-4

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