title: Endoscopic detection of dysplasia in patients with Barrett's esophagus using light-scattering spectroscopy.
abstract: OBJECTIVE
  We conducted a study to assess the potential of light-scattering spectroscopy (LSS), which can measure epithelial nuclear enlargement and crowding, for in situ detection of dysplasia in patients with Barrett's esophagus.
  
  
  METHODS
  Consecutive patients with suspected Barrett's esophagus underwent endoscopy and systematic biopsy. Before biopsy, each site was sampled by LSS using a fiberoptic probe. Diffusely reflected white light was spectrally analyzed to obtain the size distribution of cell nuclei in the mucosal layer, from which the percentage of enlarged nuclei and the degree of crowding were determined. Dysplasia was assigned if more than 30% of the nuclei exceeded 10 microm and the histologic findings compared with those of 4 pathologists blinded to the light-scattering assessment. The data were then retrospectively analyzed to further explore the diagnostic potential of LSS.
  
  
  RESULTS
  Seventy-six sites from 13 patients were sampled. All abnormal sites and a random sample of nondysplastic sites were reviewed by the pathologists. The average diagnoses were 4 sites from 4 different patients as high-grade dysplasia (HGD), 8 sites from 5 different patients as low-grade dysplasia (LGD), 12 as indefinite for dysplasia, and 52 as nondysplastic Barrett's. The sensitivity and specificity of LSS for detecting dysplasia (either LGD or HGD) were 90% and 90%, respectively, with all HGD and 87% of LGD sites correctly classified. Decision algorithms using both nuclear enlargement and crowding further improved diagnostic accuracy, and accurately classified samples into the 4 histologic categories.
  
  
  CONCLUSIONS
  LSS can reliably detect LGD and HGD in patients with Barrett's esophagus.
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Wallace
authors.forename: L T
authors.initials: LT
authors.lastname: Perelman
authors.forename: V
authors.initials: V
authors.lastname: Backman
authors.forename: J M
authors.initials: JM
authors.lastname: Crawford
authors.forename: M
authors.initials: M
authors.lastname: Fitzmaurice
authors.forename: M
authors.initials: M
authors.lastname: Seiler
authors.forename: K
authors.initials: K
authors.lastname: Badizadegan
authors.forename: S J
authors.initials: SJ
authors.lastname: Shields
authors.forename: I
authors.initials: I
authors.lastname: Itzkan
authors.forename: R R
authors.initials: RR
authors.lastname: Dasari
authors.forename: J
authors.initials: J
authors.lastname: Van Dam
authors.forename: M S
authors.initials: MS
authors.lastname: Feld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012542:Scattering, Radiation; D012680:Sensitivity and Specificity; D016037:Single-Blind Method