title: Methylene blue staining of dysplastic and nondysplastic Barrett's esophagus: an in vivo and ex vivo study.
abstract: OBJECTIVE
  Methylene blue selectively stains specialized columnar epithelium in Barrett's esophagus with high accuracy. We prospectively evaluated the methylene blue staining properties of dysplastic and nondysplastic Barrett's esophagus and the association of these properties with the risk for dysplasia and cancer.
  
  
  METHODS
  In a ex vivo study, we mapped, photographed, and sampled esophagectomy specimens with high grade dysplasia and/or early adenocarcinoma before and after methylene blue staining. In a concurrent in vivo study, we performed methylene blue staining and characterized methylene blue stain characteristics. Pathologists estimated the proportion of specialized columnar epithelium in each specimen and graded dysplasia.
  
  
  RESULTS
  We examined 551 biopsies from 47 patients with biopsy-proven Barrett's esophagus and 48 sections from five surgical specimens with Barrett's esophagus and dysplasia and early adenocarcinoma. The accuracy of ex vivo and in vivo methylene blue staining for specialized columnar epithelium was 87% and 90%, respectively. It was influenced by the length of Barrett's esophagus, biopsy location, and the presence of esophagitis and/or dysplasia. Light to absent staining (p = 0.01) and moderate to marked heterogeneity (p = 0.01) were significantly associated with high grade dysplasia or cancer in the univariate analysis and in a multivariate model that adjusted for the length of Barrett's esophagus and the presence of a lesion. These staining characteristics were present in all patients with severe dysplasia and/or adenocarcinoma.
  
  
  CONCLUSIONS
  Highly dysplastic or malignant Barrett's esophagus stains differently with methylene blue. Increased heterogeneity and decreased methylene blue stain intensity are significant independent predictors of high grade dysplasia and/or cancer. These features may help to direct biopsies in patients without a lesion.
authors.affiliation: Division of Gastroenterology, University Hospitals of Cleveland and Veterans' Administration Medical Center-Case Western Reserve University, Ohio, USA. mcanto@welchlink.welch.jhu.edu
authors.forename: M I
authors.initials: MI
authors.lastname: Canto
authors.forename: S
authors.initials: S
authors.lastname: Setrakian
authors.forename: J E
authors.initials: JE
authors.lastname: Willis
authors.forename: A
authors.initials: A
authors.lastname: Chak
authors.forename: R E
authors.initials: RE
authors.lastname: Petras
authors.forename: M V
authors.initials: MV
authors.lastname: Sivak
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D004848:Epithelium / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
chemical_list: D008751:Methylene Blue