title: Evaluation of Mutational Testing of Preneoplastic Barrett's Mucosa by Next-Generation Sequencing of Formalin-Fixed, Paraffin-Embedded Endoscopic Samples for Detection of Concurrent Dysplasia and Adenocarcinoma in Barrett's Esophagus.
abstract: Barrett's intestinal metaplasia (BIM) may harbor genomic mutations before the histologic appearance of dysplasia and cancer and requires frequent surveillance. We explored next-generation sequencing to detect mutations with the analytical sensitivity required to predict concurrent high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus by testing nonneoplastic BIM. Formalin-fixed, paraffin-embedded (FFPE) routine biopsy or endoscopic mucosal resection samples from 32 patients were tested: nonprogressors to HGD or EAC (BIM-NP) with BIM, who never had a diagnosis of dysplasia or EAC (N = 13); progressors to HGD or EAC (BIM-P) with BIM and a worse diagnosis of HGD or EAC (N = 15); and four BIM-negative samples. No mutations were detected in the BIM-NP (0 of 13) or BIM-negative samples, whereas the BIM-P samples had mutations in 6 (75%) of 8 cases in TP53, APC, and CDKN2A (P = 0.0005), detected in samples with as low as 20% BIM. We found that next-generation sequencing from routine FFPE nonneoplastic Barrett's esophagus samples can detect multiple mutations in minute areas of BIM with high analytical sensitivity. Next-generation sequencing panels for detection of TP53 and possibly combined mutations in other genes, such as APC and CDKN2A, may be useful in the clinical setting to improve dysplasia and cancer surveillance in patients with Barrett's esophagus.
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Armando
authors.initials: A
authors.lastname: Del Portillo
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lagana
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Pathology, Shinshu University, Nagano, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uehara
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nirag
authors.initials: N
authors.lastname: Jhala
authors.affiliation: Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Tapan
authors.initials: T
authors.lastname: Ganguly
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Nagy
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutierrez
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Aesis
authors.initials: A
authors.lastname: Luna
authors.affiliation: Division of Gastroenterology, Columbia University, New York City, New York.
authors.forename: Julian
authors.initials: J
authors.lastname: Abrams
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Randall
authors.initials: R
authors.lastname: Brand
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Sepulveda
authors.affiliation: Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York City, New York. Electronic address: as4400@columbia.edu.
authors.forename: Antonia R
authors.initials: AR
authors.lastname: Sepulveda
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000235:genetics; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000235:genetics; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004947:Esophagus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005557:Formaldehyde / Q000737:chemistry*; D059014:High-Throughput Nucleotide Sequencing / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000473:pathology; D009154:Mutation / Q000235:genetics*; D016612:Paraffin Embedding / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D005557:Formaldehyde