title: Simplified classification of capillary pattern in Barrett esophagus using magnifying endoscopy with narrow band imaging: implications for malignant potential and interobserver agreement.
abstract: The classification of Barrett esophagus (BE) using magnifying endoscopy with narrow band imaging (ME-NBI) is not widely used in clinical settings because of its complexity. To establish a new simplified available classification using ME-NBI.We conducted a cross-sectional study in a single-referral center. One hundred eight consecutive patients with BE using ME-NBI and crystal violet (CV) chromoendoscopy, and histological findings were enrolled. BE areas observed by ME-NBI were classified as type I or II on the basis of capillary pattern (CP), and as closed or open type on the basis of a mucosal pit pattern using CV chromoendoscopy; then, biopsy samples were obtained. We evaluated the relation between CP and pit pattern, expression of the factors with malignant potential, percentage of microvascular density, and interobserver agreement.One hundred thirty lesions from 91 patients were analyzed. Type II CP had more open type pit pattern areas and significantly greater microvascular density than type I. The presence of dysplasia, specialized intestinal metaplasia, expressions of COX-2, CDX2, and CD34, and PCNA index were significantly higher in type II, whereas the multivariate analysis showed that type II was the best predictor for the presence of dysplasia (OR 11.14), CD34 expression (OR 3.60), and PCNA (OR 3.29). Interobserver agreement for this classification was substantial (κ = 0.66).A simplified CP classification based on observation with ME-NBI is presented. Our results indicate that the classification may be useful for surveillance of BE with high malignant potential.
authors.affiliation: From the Department of Gastroenterology and Hepatology (GU, NI, Y. Tada, Y. Tamagawa, SI, YK), Shimane University School of Medicine; Division of Endoscopy (TY), Shimane University Hospital; Department of Pathology (TM, RM), Shimane University School of Medicine, Izumo; Division of Endoscopy (YA), Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan; and Department of Internal Medicine (Y. Tamagawa), University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Goichi
authors.initials: G
authors.lastname: Uno
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishimura
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Tada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tamagawa
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
authors.forename: Shunji
authors.initials: S
authors.lastname: Ishihara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Amano
authors.forename: Riruke
authors.initials: R
authors.lastname: Maruyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D001471:Barrett Esophagus / Q000145:classification* / Q000378:metabolism / Q000473:pathology*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D000071616:CDX2 Transcription Factor; D002196:Capillaries / Q000473:pathology*; D003430:Cross-Sectional Studies; D051546:Cyclooxygenase 2 / Q000378:metabolism; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D004947:Esophagus / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology; D005260:Female; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D015588:Observer Variation; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D012307:Risk Factors
chemical_list: D018952:Antigens, CD34; D015415:Biomarkers; D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; D018809:Proliferating Cell Nuclear Antigen; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human