Detection of Dysplasia in Barrett's Esophagus With In Vivo Depth-Resolved Nuclear Morphology Measurements

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 140; no. 1; pp. 42 - 50
• Main Authors: Terry, Neil G, Zhu, Yizheng, Rinehart, Matthew T, Brown, William J, Gebhart, Steven C, Bright, Stephanie, Carretta, Elizabeth, Ziefle, Courtney G, Panjehpour, Masoud, Galanko, Joseph, Madanick, Ryan D, Dellon, Evan S, Trembath, Dimitri, Bennett, Ana, Goldblum, John R, Overholt, Bergein F, Woosley, John T, Shaheen, Nicholas J, Wax, Adam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2011
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Barrett Esophagus - diagnosis; Barrett Esophagus - pathology; Barrett's Esophagus; Cell Nucleus - pathology; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - pathology; Esophagoscopy - methods; Esophagus - pathology; Female; Gastroenterology and Hepatology; Humans; Interferometry - methods; Light; Light Scattering; Male; Middle Aged; Optical Techniques; Scattering, Radiation; Sensitivity and Specificity; BE; HGD; Barrett's Esophagus; CI; ROC; LGD; a/LCI; angle-resolved low coherence interferometry; area under the curve; Optical Techniques; low-grade dysplasia; AUC; Light Scattering; confidence interval; high-grade dysplasia; receiver operating characteristic
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/j.gastro.2010.09.008

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.