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Detection of dysplasia in Barrett's esophagus with in vivo depth-resolved nuclear morphology measurements.

Abstract：

BACKGROUND & AIMS:Patients with Barrett's esophagus (BE) show increased risk of developing esophageal adenocarcinoma and are routinely examined using upper endoscopy with biopsy to detect neoplastic changes. Angle-resolved low coherence interferometry (a/LCI) uses in vivo depth-resolved nuclear morphology measurements to detect dysplasia. We assessed the clinical utility of a/LCI in the endoscopic surveillance of patients with BE. METHODS:Consecutive patients undergoing routine surveillance upper endoscopy for BE were recruited at 2 endoscopy centers. A novel, endoscope-compatible a/LCI system measured the mean diameter and refractive index of cell nuclei in esophageal epithelium at 172 biopsy sites in 46 patients. At each site, an a/LCI measurement was correlated with a concurrent endoscopic biopsy specimen. Each biopsy specimen was assessed histologically and classified as normal, nondysplastic BE, indeterminate for dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). The a/LCI data from multiple depths were analyzed to evaluate its ability to differentiate dysplastic from nondysplastic tissue. RESULTS:Pathology characterized 5 of the scanned sites as HGD, 8 as LGD, 75 as nondysplastic BE, 70 as normal tissue types, and 14 as indeterminate for dysplasia. The a/LCI nuclear size measurements separated dysplastic from nondysplastic tissue at a statistically significant (P < .001) level for the tissue segment 200 to 300 μm beneath the surface with an accuracy of 86% (147/172). A receiver operator characteristic analysis indicated an area under the curve of 0.91, and an optimized decision point gave 100% (13/13) sensitivity and 84% (134/159) specificity. CONCLUSIONS:These preliminary data suggest a/LCI is accurate in detecting dysplasia in vivo in patients with BE.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Terry NG,Zhu Y,Rinehart MT,Brown WJ,Gebhart SC,Bright S,Carretta E,Ziefle CG,Panjehpour M,Galanko J,Madanick RD,Dellon ES,Trembath D,Bennett A,Goldblum JR,Overholt BF,Woosley JT,Shaheen NJ,Wax A

doi

10.1053/j.gastro.2010.09.008

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

42-50

issue

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(10)01324-7

journal_volume

140

pub_type

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Detection of dysplasia in Barrett's esophagus with in vivo depth-resolved nuclear morphology measurements.