Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
Endoscopy. 2013 Jun;45(6):426-32. doi: 10.1055/s-0032-1326630. Epub 2013 Jun 3.
Acetic acid reacts with Barrett's mucosa to produce acetowhitening which disappears with time. The clinical significance of this is unknown. We aimed to quantify the acetowhitening time, developing an objective tool for diagnosis of neoplasia in Barrett's esophagus.
Prospective cohort study in a tertiary referral center, enrolling patients undergoing surveillance of Barrett's metaplasia or referred with suspected neoplasia. Acetic acid 2.5 % was applied to the mucosa via a spray catheter. Acetowhitening was observed and time to disappearance recorded. Targeted biopsies of any neoplasia and quadrantic 2-cm biopsies of residual Barrett's area were then taken. Histological findings were investigated in relation to duration of acetowhitening.
132 patients were examined. A receiver operating characteristic (ROC) curve was produced for identifying high risk neoplasia according to acetowhitening duration. The area under the curve (AUC) was 0.93 (0.89 - 0.97). Using a threshold of 142 seconds yielded a sensitivity for neoplasia of 98 % (95 % confidence interval [95 %CI] 89 % - 100 %) and specificity of 84 % (74 % - 91 %). The ROC curve for mucosal neoplasia (high grade dysplasia or intramucosal carcinoma) versus deep invasive cancer showed an AUC of 0.786 (0.61 - 0.96); a cutoff of 20 seconds yielded a sensitivity and specificity for invasive cancer of 67 % (35 % - 90 %) and 85 % (69 % - 95 %), respectively.
The time to disappearance of acetowhitening can serve as a simple but very sensitive tool for the diagnosis of high risk neoplasia in Barrett's esophagus. It can be used to distinguish mucosal neoplasia from deep invasive cancer.
醋酸与 Barrett 黏膜反应产生醋酸白变，随时间消失。其临床意义尚不清楚。我们旨在量化醋酸白变时间，为 Barrett 食管的肿瘤诊断开发一种客观的工具。
这是一项在三级转诊中心进行的前瞻性队列研究，纳入接受 Barrett 化生监测或因疑似肿瘤而转诊的患者。通过喷雾导管将 2.5%的醋酸应用于黏膜。观察醋酸白变并记录消失时间。然后对任何肿瘤进行靶向活检，并对残留的 Barrett 区域进行 2cm 四分位活检。调查了醋酸白变时间与组织学发现的关系。
共检查了 132 例患者。根据醋酸白变持续时间绘制了识别高危肿瘤的受试者工作特征（ROC）曲线。曲线下面积（AUC）为 0.93（0.89-0.97）。使用 142 秒的阈值，肿瘤的敏感性为 98%（95%CI 89%-100%），特异性为 84%（74%-91%）。黏膜肿瘤（高级别异型增生或黏膜内癌）与深部浸润性癌的 ROC 曲线 AUC 为 0.786（0.61-0.96）；20 秒的截断值对浸润性癌的敏感性和特异性分别为 67%（35%-90%）和 85%（69%-95%）。
醋酸白变消失时间可作为 Barrett 食管高危肿瘤诊断的简单而非常敏感的工具。它可用于区分黏膜肿瘤与深部浸润性癌。
