Original ArticleHistopathologic Aspects of Photodynamic Therapy for Dysplasia and Early Adenocarcinoma Arising in Barrett’s EsophagusBan, Shinichi MD*†; Mino, Mari MD*; Nishioka, Norman S MD‡; Puricelli, William RN, CRC‡; Zukerberg, Lawrence R MD*; Shimizu, Michio MD†; Lauwers, Gregory Y MD*Author Information From the Departments of *Pathology, Gastrointestinal Pathology Service, and ‡Medicine (Gastrointestinal Unit), Massachusetts General Hospital, Boston, MA; and †Department of Pathology, Saitama Medical School, Saitama, Japan. Reprints: Gregory Y. Lauwers, MD, Gastrointestinal Pathology Service, Department of Pathology (WRN #2), Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696 (e-mail: email@example.com). The American Journal of Surgical Pathology: November 2004 - Volume 28 - Issue 11 - p 1466-1473 doi: 10.1097/01.pas.0000141392.91677.7f Buy SDC Metrics Abstract The efficacy of photodynamic therapy (PDT) is currently evaluated for the treatment of superficial neoplasms arising in Barrett’s esophagus (BE). An accurate assessment of this technique requires the evaluation of biopsies before and after treatment. However, despite the importance of pathology, only a limited number of studies have systematically assessed the mucosal changes after PDT. To evaluate mucosal changes after PDT, and pathologic variables that may impact on the success of this therapy, we analyzed the pre- and post-PDT biopsies of a cohort of patients treated by this modality. Thirty-three patients (mean age, 71 years) with high-grade dysplasia (HGD) and/or intramucosal carcinoma (IMC) arising in BE and followed up after PDT using Porfimer sodium form the basis of this study. In all patients, a review of all pre- and post-PDT biopsies was performed. The variables recorded included the histologic grade and architecture of neoplasms, the distribution of neoplasms, and squamous re-epithelialization. IMC and HGD coexisted in the pre-PDT biopsies of 18 patients (54.5%). IMC and HGD showed a prominent tubular proliferation in 14 patients and displayed a papillary pattern (at least partially) in 19 patients. In post-PDT, patches of specialized columnar epithelium were buried under squamous epithelium in 17 patients (51.5%), and foci of dysplasia/carcinoma covered by squamous epithelium were found in 9 patients (27.3%). HGD and/or IMC were eradicated in 17 patients (eradicated group) and persisted in 16 patients (persistent group). In the persistent group, grade and architecture were unchanged after PDT in 62.5% and 87.5% of patients, respectively. The persistent group was characterized by: 1) a more frequent papillary architecture (P < 0.05), and 2) a diffuse distribution of the neoplasms on pre-PDT biopsies (P = 0.05). Singularly, the persistent neoplastic lesions were observed in the distal esophagus (P < 0.05). A systematic histopathologic evaluation allowed us to draw attention to the fact that distally located and papillary-type neoplasia seem resistant to PDT. The higher than expected incidence of buried residual neoplastic epithelium should also be emphasized since it represents a risk for undetected growth of malignancy. © 2004 Lippincott Williams & Wilkins, Inc.