title: Qualitative mapping of Barrett's metaplasia: a prerequisite for intervention trials.
abstract: BACKGROUND
  Barrett's esophagus may present as a cellular mosaic with irregular longitudinal extensions of intestinal epithelium, spotty areas of dysplasia and other intermediate markers for cancer risk. It may not be possible to detect and reproducibly localize these findings with routine endoscopic biopsies. A more systematic biopsy protocol is necessary for chemopreventive studies to be feasible.
  
  
  METHODS
  Utilizing an adapted upper endoscope that allows accurate evaluation of distance from the incisors and rotatory position, chromoendoscopy with toluidine blue and systematic mapping (4 quadrant jumbo biopsies at 1 cm intervals) were performed twice on 18 patients with Barrett's esophagus (second procedure 1 to 3 months after baseline study). All biopsy specimens were subjected to routine and immunohistochemical staining and flow cytometry to create baseline and follow-up maps for each patient. Eight of the 18 patients also underwent standard surveillance biopsies within 6 months of the systematic mapping procedures.
  
  
  RESULTS
  Epithelium type was reproducibly identified with 94% accuracy on second endoscopic maps. Ploidy, p53, and Ki-67 status were also reproducibly identified on second endoscopic maps (97%, 89%, and 85%, respectively). Dysplasia was found in 7 of 18 patients at similar sites at each mapping procedure (3 patients with high-grade dysplasia, 4 with low-grade dysplasia). Five of the patients who had dysplasia on mapping had also undergone standard surveillance. Low-grade dysplasia was missed in 2 of 3 patients and 1 patient with high-grade dysplasia had only low-grade dysplasia detected with standard biopsies.
  
  
  CONCLUSIONS
  Utilizing a modified gastroscope and this methodology, we reliably located sites of dysplasia and other biomarkers within a field of Barrett's esophagus. Patients had variable areas of dysplasia that were missed on standard endoscopic surveillance.
authors.affiliation: Division of Gastroenterology, Department of Pathology, and the Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Eisen
authors.forename: E A
authors.initials: EA
authors.lastname: Montgomery
authors.forename: N
authors.initials: N
authors.lastname: Azumi
authors.forename: D P
authors.initials: DP
authors.lastname: Hartmann
authors.forename: P
authors.initials: P
authors.lastname: Bhargava
authors.forename: M
authors.initials: M
authors.lastname: Lippman
authors.forename: S B
authors.initials: SB
authors.lastname: Benjamin
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D002648:Child; D004848:Epithelium / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology*; D020701:Esophagoscopes; D004947:Esophagus / Q000473:pathology; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019394:Ki-67 Antigen / Q000032:analysis; D008679:Metaplasia; D008875:Middle Aged; D011003:Ploidies; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D014048:Tolonium Chloride; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D014048:Tolonium Chloride