Borovicka J, Schönegg R, Hell M, Kradolfer D, Bauerfeind P, Dorta G, Netzer P, Binek J, Meyenberger C, Fischer J E, Spieler P
Division of Gastroenterology, Department of Internal Medicine, Cantonal Hospital, St Gall, Switzerland.
Endoscopy. 2009 May;41(5):409-14. doi: 10.1055/s-0029-1214641. Epub 2009 May 5.
The current gold standard in Barrett's esophagus monitoring consists of four-quadrant biopsies every 1-2 cm in accordance with the Seattle protocol. Adding brush cytology processed by digital image cytometry (DICM) may further increase the detection of patients with Barrett's esophagus who are at risk of neoplasia. The aim of the present study was to assess the additional diagnostic value and accuracy of DICM when added to the standard histological analysis in a cross-sectional multicenter study of patients with Barrett's esophagus in Switzerland.
One hundred sixty-four patients with Barrett's esophagus underwent 239 endoscopies with biopsy and brush cytology. DICM was carried out on 239 cytology specimens. Measures of the test accuracy of DICM (relative risk, sensitivity, specificity, likelihood ratios) were obtained by dichotomizing the histopathology results (high-grade dysplasia or adenocarcinoma vs. all others) and DICM results (aneuploidy/intermediate pattern vs. diploidy).
DICM revealed diploidy in 83% of 239 endoscopies, an intermediate pattern in 8.8%, and aneuploidy in 8.4%. An intermediate DICM result carried a relative risk (RR) of 12 and aneuploidy a RR of 27 for high-grade dysplasia/adenocarcinoma. Adding DICM to the standard biopsy protocol, a pathological cytometry result (aneuploid or intermediate) was found in 25 of 239 endoscopies (11%; 18 patients) with low-risk histology (no high-grade dysplasia or adenocarcinoma). During follow-up of 14 of these 18 patients, histological deterioration was seen in 3 (21%).
DICM from brush cytology may add important information to a standard biopsy protocol by identifying a subgroup of BE-patients with high-risk cellular abnormalities.
目前巴雷特食管监测的金标准是按照西雅图方案，每隔1 - 2厘米进行四象限活检。添加经数字图像细胞术（DICM）处理的刷检细胞学检查可能会进一步提高对有肿瘤形成风险的巴雷特食管患者的检测率。本研究的目的是在瑞士一项针对巴雷特食管患者的横断面多中心研究中，评估DICM添加到标准组织学分析后额外的诊断价值和准确性。
164例巴雷特食管患者接受了239次内镜检查，包括活检和刷检细胞学检查。对239份细胞学标本进行了DICM检查。通过将组织病理学结果（高级别异型增生或腺癌与其他所有结果）和DICM结果（非整倍体/中间模式与二倍体）进行二分法分析，获得了DICM的检测准确性指标（相对风险、敏感性、特异性、似然比）。
在239次内镜检查中，DICM显示83%为二倍体，8.8%为中间模式，8.4%为非整倍体。DICM结果为中间模式时，高级别异型增生/腺癌的相对风险（RR）为12，非整倍体时RR为27。在标准活检方案中添加DICM后，在239次内镜检查中有25次（11%；18例患者）出现低风险组织学结果（无高级别异型增生或腺癌）的病理细胞学结果（非整倍体或中间模式）。在这18例患者中的14例随访期间，3例（21%）出现了组织学恶化。
刷检细胞学的DICM可能通过识别一组具有高风险细胞异常的巴雷特食管患者，为标准活检方案增添重要信息。
