title: The effect of reactive atypia/inflammation on the laser-induced fluorescence diagnosis of non-dysplastic Barrett's esophagus.
abstract: OBJECTIVE
  Differential Normalized Fluorescence (DNF) technique has been used to distinguish high-grade dysplasia from non-dysplastic Barrett's esophagus. This technology may assist gastroenterologists in targeting biopsies, reducing the number of biopsies using the standard protocol. In the presence of reactive atypia/inflammation, it becomes difficult for the pathologist to differentiate non-dysplastic Barrett's esophagus from Barrett's esophagus with low-grade dysplasia. Before DNF technique may be used to guide target biopsies, it is critical to know whether reactive atypia/inflammation in non-dysplastic Barrett's may result in false positives. This study was conducted to determine whether DNF technique is adversely affected by the presence of reactive atypia/inflammation in non-dysplastic Barrett's esophagus resulting in false positives.
  
  
  METHODS
  Four hundred ten-nanometer laser light was used to induce autofluorescence of Barrett's mucosa in 49 patients. The clinical study included 37 males and 12 females. This was a blinded retrospective data analysis study. A total of 303 spectra were collected and matched to non-dysplastic Barrett's biopsy results. One hundred seventy-five spectra were collected from areas with a pathology of non-dysplastic Barrett's esophagus with reactive atypia/inflammation. One hundred twenty-eight spectra were collected from areas with non-dysplastic Barrett's esophagus without reactive changes/inflammation. The spectra were analyzed using the DNF Index at 480 nm and classified as positive or negative using the threshold of -0.75 × 10(-3).
  
  
  RESULTS
  Using DNF technique, 92.6% of non-dysplastic samples with reactive atypia/inflammation were classified correctly (162/175). 92.2% of non-dysplastic samples without reactive atypia/inflammation were classified correctly (118/128). Comparing the ratios of false positives among the two sample groups, there was not a statistically significant difference between the two groups.
  
  
  CONCLUSIONS
  Using DNF technique for classification of non-dysplastic Barrett's mucosa does not result in false-positive readings due to reactive atypia/inflammation. Target biopsies guided by DNF technique may drastically reduce the number of pinch biopsies using the standard biopsy protocol.
authors.affiliation: Laser Center, Thompson Cancer Survival Center, Knoxville, TN 37916, USA. mpanjehp@covhlth.com
authors.forename: Masoud
authors.initials: M
authors.lastname: Panjehpour
authors.forename: Bergein F
authors.initials: BF
authors.lastname: Overholt
authors.forename: Tuan
authors.initials: T
authors.lastname: Vo-Dinh
authors.forename: Domenico
authors.initials: D
authors.lastname: Coppola
mesh_terms: D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology*; D001706:Biopsy; D003937:Diagnosis, Differential; D004945:Esophagoscopy / Q000295:instrumentation / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D054025:Lasers, Dye; D008297:Male; D012189:Retrospective Studies; D016037:Single-Blind Method; D013050:Spectrometry, Fluorescence / Q000295:instrumentation / Q000379:methods*