Value of DNA image cytometry in the prediction of malignant change in Barrett's oesophagus.

DNA image cytometry was performed on Feulgen stained sections from 91 biopsies obtained during prospective endoscopic surveillance of 55 patients with Barrett's oesophagus. Aneuploid cells were detected in specimens from six of these patients. Four subsequently developed dysplasia and adenocarcinoma but, in the other two, biopsies had been reported as showing specialised epithelium only, with no apparent dysplasia and no evidence of malignancy on clinical follow up to date. In two of the four patients who subsequently developed carcinoma, aneuploid cells were only found in biopsies showing overt dysplasia or carcinoma but in the two other patients aneuploid cells were present in biopsies taken early in the clinical course before any dysplasia had been identified on the original reports. The presence of aneuploid cells on cytometry of these 'benign' biopsies allowed us, on histological review, to identify areas of atypia which were interpreted as mild dysplasia. In this series aneuploidy was always associated with some morphological abnormality varying from mild dysplasia to frank carcinoma. Aneuploid cells were not shown in material from one patient who had an oesophagectomy for dysplasia or in biopsy material from four patients showing 'indefinite dysplasia'. DNA cytometry combines an objective assessment of epithelial atypia with the advantage of detecting rare cellular aneuploidy and the ability to correlate these events with morphology. It should assist in the more accurate diagnosis of dysplasia and prove useful in identifying those patients with Barrett's oesophagus who are at greater risk of subsequently developing malignancy.