title: Detection of dysplasia in Barrett's esophagus with in vivo depth-resolved nuclear morphology measurements.
abstract: 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.
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Terry
authors.forename: Yizheng
authors.initials: Y
authors.lastname: Zhu
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rinehart
authors.forename: William J
authors.initials: WJ
authors.lastname: Brown
authors.forename: Steven C
authors.initials: SC
authors.lastname: Gebhart
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bright
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carretta
authors.forename: Courtney G
authors.initials: CG
authors.lastname: Ziefle
authors.forename: Masoud
authors.initials: M
authors.lastname: Panjehpour
authors.forename: Joseph
authors.initials: J
authors.lastname: Galanko
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madanick
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.forename: Dimitri
authors.initials: D
authors.lastname: Trembath
authors.forename: Ana
authors.initials: A
authors.lastname: Bennett
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Bergein F
authors.initials: BF
authors.lastname: Overholt
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Adam
authors.initials: A
authors.lastname: Wax
mesh_terms: 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