Detection of dysplasia in Barrett's esophagus with in vivo depth-resolved nuclear morphology measurements.
OBJECTIVE
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.
Terry
Neil G
NG
Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
Zhu
Yizheng
Y
Rinehart
Matthew T
MT
Brown
William J
WJ
Gebhart
Steven C
SC
Bright
Stephanie
S
Carretta
Elizabeth
E
Ziefle
Courtney G
CG
Panjehpour
Masoud
M
Galanko
Joseph
J
Madanick
Ryan D
RD
Dellon
Evan S
ES
Trembath
Dimitri
D
Bennett
Ana
A
Goldblum
John R
JR
Overholt
Bergein F
BF
Woosley
John T
JT
Shaheen
Nicholas J
NJ
Wax
Adam
A
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D002467:Cell Nucleus / Q000473:pathology; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D007368:Interferometry / Q000379:methods; D008027:Light; D008297:Male; D008875:Middle Aged; D012542:Scattering, Radiation; D012680:Sensitivity and Specificity