Haggitt R C, Reid B J, Rabinovitch P S, Rubin C E
Department of Pathology, University of Washington, Seattle.
Am J Pathol. 1988 Apr;131(1):53-61.
A predominance of sulfated mucin in the nongoblet columnar cells of Barrett's specialized metaplastic epithelium has been postulated to be a form of mild dysplasia and to indicate an increased risk of adenocarcinoma. Flow cytometry for the analysis of nuclear DNA content and cell cycle parameters has also been postulated to be an objective aid in the diagnosis of dysplasia and carcinoma in Barrett's esophagus. The authors investigated the relationship among sulfated mucin, flow cytometric data, and histologic diagnosis in each of 152 biopsies from 42 patients who had Barrett's specialized metaplastic epithelium. Sulfated mucin, as detected by the high iron diamine-Alcian blue stain, was present in biopsies from 8 of 11 (73%) patients with the histologic diagnosis of dysplasia or carcinoma, in 7 of 9 (78%) patients whose biopsies were indefinite for dysplasia, and in 12 of 22 (55%) patients whose biopsies were negative for dysplasia (P = 0.37). Sulfated mucins predominated in 9%, 22%, and 9% of the patients, respectively (P = 0.56). Abnormal flow cytometry (aneuploidy or increased G2/tetraploid fraction) was found in all patients with the histologic diagnosis of dysplasia or carcinoma, in 3 of 9 (33%) indefinite for dysplasia, and in 1 of 22 (5%) negative for dysplasia (P = less than 0.0001). Neither the presence nor the predominance of sulfated mucin in the specialized metaplastic epithelium of Barrett's esophagus has sufficiently high sensitivity or specificity for dysplasia or carcinoma to be of value in managing patients. Abnormal flow cytometry shows excellent correlation with the histologic diagnosis of dysplasia and carcinoma; it detects a subset of patients whose biopsies are histologically indefinite or negative for dysplasia, but who have flow cytometric abnormalities similar to those otherwise seen only in dysplasia and carcinoma.
据推测，巴雷特特殊化生上皮的非杯状柱状细胞中硫酸化粘蛋白占优势是一种轻度发育异常的形式，提示腺癌风险增加。用于分析核DNA含量和细胞周期参数的流式细胞术也被认为是辅助诊断巴雷特食管发育异常和癌变的一种客观方法。作者研究了42例患有巴雷特特殊化生上皮的患者的152份活检样本中硫酸化粘蛋白、流式细胞术数据和组织学诊断之间的关系。通过高铁二胺 - 阿尔辛蓝染色检测到的硫酸化粘蛋白，在11例组织学诊断为发育异常或癌变的患者中有8例（73%）的活检样本中存在，在9例活检结果不确定是否为发育异常的患者中有7例（78%）存在，在22例活检结果为发育异常阴性的患者中有12例（55%）存在（P = 0.37）。硫酸化粘蛋白分别在9%、22%和9%的患者中占优势（P = 0.56）。所有组织学诊断为发育异常或癌变的患者均发现流式细胞术异常（非整倍体或G2/四倍体分数增加），在9例活检结果不确定是否为发育异常的患者中有3例（33%）存在异常，在22例活检结果为发育异常阴性的患者中有1例（5%）存在异常（P < 0.0001）。巴雷特食管特殊化生上皮中硫酸化粘蛋白的存在或占优势对于发育异常或癌变而言，其敏感性或特异性均不够高，因而在患者管理中没有价值。流式细胞术异常与发育异常和癌变的组织学诊断具有良好的相关性；它能检测出一部分活检组织学结果不确定或为发育异常阴性，但流式细胞术异常类似于仅在发育异常和癌变中所见的患者。
