Guidance
The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus in July 2014.
Description
Squamous dysplasia of the oesophagus consists of flat premalignant epithelial lesions that may progress to squamous cell carcinoma. Histological features of squamous dysplasia include cellular disorganisation, loss of polarity and downward growth of the epithelium. Cytological abnormalities include hyperchromasia, increased nucleus to cytoplasm ratio, and mitotic activity. The World Health Organization’s (WHO) histologic classification of gastrointestinal tumours refers to squamous dysplasia as squamous intra-epithelial neoplasia (defined as non-invasive cytological or architectural alterations that may lead to development of invasive cancer) and categorises it as either low- or high-grade. Low-grade squamous neoplasia is associated with a low risk of progression to invasive squamous cell carcinoma. Histological and cytological changes are moderate and involve the lower half of the epithelium. High-grade intraepithelial neoplasia carries a higher risk of progression to invasive squamous cell carcinoma. Abnormalities involve the upper half of the epithelium, and cytological changes are greater than those in low-grade intraepithelial neoplasia.
Squamous cancer of the oesophagus can be treated by surgery (oesophagectomy) or chemoradiotherapy or a combination of these methods. When the disease is detected at an earlier pre-invasive stage such as carcinoma in situ or high-grade dysplasia, then endoscopic treatment is possible. Methods include removal by endoscopic mucosal resection or endoscopic submucosal dissection, and ablation using photodynamic therapy, argon plasma coagulation, laser ablation, cryotherapy or multipolar electrocoagulation.
Coding recommendations
G14.5 Fibreoptic endoscopic destruction of lesion of oesophagus NEC
Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC
Includes: Radiofrequency ablation of lesion of organ NOC
When the examination is not limited to the oesophagus, the following OPCS-4 codes are assigned:
G43.5 Fibreoptic endoscopic destruction of lesion of upper gastrointestinal tract NEC
Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC
Includes: Radiofrequency ablation of lesion of organ NOC
Z27.1 Oesophagus
The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.