NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America.
NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America.
Ann Diagn Pathol. 2022 Oct;60:151982. doi: 10.1016/j.anndiagpath.2022.151982. Epub 2022 May 28.
Barrett's esophagus (BE) is a premalignant condition that leads to susceptibility to developing adenocarcinoma. The most common endoscopic surveillance technique is forceps biopsy, which involves sampling the specimen every 1 to 2 cm along the length of the lesion. This technique has a low sensitivity and often leaves the majority of the esophageal mucosa untested. Recently, the use of wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) has received much attention. However, there is little known about this novel technique, and this research aims to add to our knowledge of WATS-3D by comparing it to traditional forceps biopsy.
A retrospective observational study was performed. All existing GI biopsy cases diagnosed with WATS-3D were identified from the institutional pathology databases of NYU Langone Hospital - Long Island from 2019 to 2021. Data collection included patients' age, sex, and dysplasia results. Existing pathology reports and CDx diagnostics were reviewed. All the existing slides of the biopsy cases were pulled out and reviewed. Dysplasia was classified as no dysplasia, indefinite for dysplasia, lowgrade dysplasia, and high-grade dysplasia.
A total of 109 cases were included in this study. There are 59 cases diagnosed as BE with forceps biopsy, 72 cases by WATS-3D, and 77 cases by WATS-3D combined with forceps biopsy. The sensitivity of detecting BE was significantly increased by WATS-3D and further by WATS-3D combined with forceps biopsy. In 59 cases diagnosed as BE with forceps biopsy, 50 cases were classified as no dysplasia, 3 cases were indefinite for dysplasia, 5 cases were low-grade dysplasia, and 1 case was high-grade dysplasia. In 72 cases diagnosed as BE by WATS-3D, 64 cases were classified as no dysplasia, 7 cases were indefinite for dysplasia, 1 case was high-grade dysplasia, and no cases with low-grade dysplasia. In 77 cases diagnosed as BE by WATS-3D combined with forceps biopsy, 63 cases were classified as no dysplasia, 8 cases were indefinite for dysplasia, 5 cases with low-grade dysplasia, and 1 case was highgrade dysplasia. The maximal longitudinal extent of the esophageal mucosal changes strongly correlated with the severity of BE.
Compared to traditional forceps biopsy, WATS-3D was more sensitive in finding intestinal metaplasia. However, WATS-3D could not clearly discriminate low-grade dysplasia from indefinite for dysplasia and tended to classify low-grade dysplasia as indefinite for dysplasia. The addition of WATS-3D to forceps biopsy resulted in an increase in diagnostic yield and thus an increase in the quality of patient care.
巴雷特食管（BE）是一种癌前病变，易发展为腺癌。最常见的内镜监测技术是活检钳活检，该技术每隔 1 至 2 厘米沿病变长度取样。该技术的敏感性较低，通常会留下大部分食管黏膜未被检测到。最近，计算机辅助三维分析的大面积跨上皮采样（WATS-3D）的应用引起了广泛关注。然而，对于这项新技术，我们知之甚少，本研究旨在通过与传统活检钳活检进行比较，增加对 WATS-3D 的了解。
这是一项回顾性观察性研究。从 2019 年至 2021 年，从 NYU Langone 医院长岛分校的机构病理学数据库中确定了所有诊断为 WATS-3D 的现有胃肠道活检病例。数据收集包括患者的年龄、性别和发育不良结果。回顾了现有的病理报告和 CDx 诊断。取出并审查了所有活检病例的现有幻灯片。发育不良分为无发育不良、发育不良不确定、低级别发育不良和高级别发育不良。
本研究共纳入 109 例患者。其中，59 例经活检钳诊断为 BE，72 例经 WATS-3D 诊断，77 例经 WATS-3D 联合活检钳诊断。WATS-3D 显著提高了检测 BE 的敏感性，WATS-3D 联合活检钳进一步提高了敏感性。在 59 例经活检钳诊断为 BE 的病例中，50 例为无发育不良，3 例为发育不良不确定，5 例为低级别发育不良，1 例为高级别发育不良。在 72 例经 WATS-3D 诊断为 BE 的病例中，64 例为无发育不良，7 例为发育不良不确定，1 例为高级别发育不良，无低级别发育不良病例。在 77 例经 WATS-3D 联合活检钳诊断为 BE 的病例中，63 例为无发育不良，8 例为发育不良不确定，5 例为低级别发育不良，1 例为高级别发育不良。食管黏膜变化的最大纵向范围与 BE 的严重程度密切相关。
与传统活检钳活检相比，WATS-3D 更能敏感地发现肠上皮化生。然而，WATS-3D 不能明确区分低级别发育不良和发育不良不确定，倾向于将低级别发育不良归类为发育不良不确定。WATS-3D 联合活检钳的应用提高了诊断率，从而提高了患者的护理质量。
