title: Nuclear Nano-architecture Markers of Gastric Cardia and Upper Squamous Esophagus Detect Esophageal Cancer "Field Effect".
abstract: BACKGROUND
  Barrett's esophagus (BE) affects up to 12 million Americans and confers an increased risk for development of esophageal adenocarcinoma (EAC). EAC is often fatal unless detected early. Given the high prevalence, high cost of surveillance and relatively low risk of most affected individuals, identification of high-risk patients for additional scrutiny, regular surveillance, or ablative therapy is crucial. The exploration of "field effect" by probing uninvolved esophageal mucosa to predict the risk of EAC has the potential as an improved surveillance and prevention strategy. In this study, we evaluate the ability of nuclear nano-architecture markers from normal squamous esophagus and gastric cardia to detect the "field effect" of esophageal dysplasia and EAC, and their response to endoscopic therapy.
  
  
  METHODS
  Patients with normal esophagus, gastroesophageal reflux, BE and EAC were eligible for enrollment. We performed endoscopic cytology brushings of the gastric cardia, ~1-2 cm below the gastroesophageal junction, and of the normal squamous esophageal mucosa at ~20 cm from the incisors and standard cytology slides were made using Thinprep method. Optical analysis was performed on the cell nuclei of cytologically normal-appearing epithelial cells.
  
  
  RESULTS
  The study cohort consisted of 128 patients. The nuclear nano-architecture markers detected the presence of esophageal dysplasia and EAC with statistical significance. The field effect does not exhibit a spatial dependence. These markers reverted toward normal in response to endoscopic therapy.
  
  
  CONCLUSIONS
  Optical analysis of gastric cardia and upper squamous esophagus represents a potentially viable method to improve risk stratification and ease of surveillance of patients with Barrett's esophagus and to monitor the efficacy of ablative therapy.
authors.affiliation: 1. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Fasanella
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Bista
authors.forename: Kevin
authors.initials: K
authors.lastname: Staton
authors.forename: Sumera
authors.initials: S
authors.lastname: Rizvi
authors.forename: Shikhar
authors.initials: S
authors.lastname: Uttam
authors.forename: Chengquan
authors.initials: C
authors.lastname: Zhao
authors.forename: Antonia
authors.initials: A
authors.lastname: Sepulveda
authors.forename: Randall E
authors.initials: RE
authors.lastname: Brand
authors.forename: Kevin
authors.initials: K
authors.lastname: McGrath
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
keywords: dysplasia; esophagus; field effect.; nanoscale; nuclear architecture