I-SCAN targeted versus random biopsies in Barrett's oesophagus.
BACKGROUND
The accuracy and effectiveness of targeted oesophageal biopsies in Barrett's oesophagus to detect dysplasia using new magnification techniques are unknown. Aim of this study was to investigate whether the combined use of acetic acid, magnification and electronic filters allows the same accuracy as the four-quadrant random biopsies pattern; pathologist interobserver agreement both in low grade and high grade dysplasia was also assessed.


METHODS
Fifty-four consecutive patients newly diagnosed with Barrett's oesophagus were enrolled in a prospective study from a single endoscopy unit. Biopsies were evaluated by the local pathologist and by an expert pathologist from another pathology unit.


METHODS
Dysplasia detection rate and interobserver agreement for the histologic diagnosis of dysplasia.


RESULTS
The use of acetic acid, magnification and electronic filters showed an unacceptably low dysplasia detection rate by the two pathologists (9.2% and 5.5% for targeted biopsies, respectively). The interobserver agreement for low grade dysplasia between pathologists was low (Cohen's K weighted=0.45).


CONCLUSIONS
In an average setting, the standard four-quadrant method should still be preferred, along with the implementation of a routine second evaluation by an expert pathologist.
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy. Electronic address: karleorn@gmail.com.
Carlo
C
Verna
Pathology Unit, Cardinal Massaia Hospital, Asti, Italy.
Elda
E
Feyles
Department of Pathology, Spedali Civili, Brescia, Italy.
Luisa
L
Lorenzi
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy.
Emanuela
E
Rolle
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy.
Mario
M
Grassini
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy.
Ugo
U
Giacobbe
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy.
Paolo
P
Niola
Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy.
Edda
E
Battaglia
Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
Gabrio
G
Bassotti
Department of Pathology, Spedali Civili, Brescia, Italy.
Vincenzo
V
Villanacci
D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies
D007202:Indicators and Reagents; D019342:Acetic Acid
Barrett's oesophagus; Dysplasia; Electronic optical filters; Endoscopy; Observer variability