Assessment of proliferating cell nuclear antigen expression in dysplastic intestinal type Barrett's esophagus. Gruppo Operativo per lo Studio delle Precancerosi Esofagee.

In the management of patients with Barrett's Esophagus (BE) the definition of a sub-group of patients at high risk for malignant transformation of the metaplastic epithelium is important. Undoubtedly, the histological evaluation of dysplasia is the most important and objective parameter to identify a malignant transformation of BE. In order to obtain additional data a group of cell proliferation markers was applied in dysplastic lesions. We studied PCNA in a selected group of patients with BE. One hundred six biopsies were examined, referring to fifty five patients with BE, who were followed up for a period of at least one year (1-5 years). All patients showed one or more biopsies positive for dysplasia. PCNA was detected immunohistochemically on formalin fixed and paraffin embedded biopsies, and positive cells were evaluated in a crude percent count. Our results showed a remarkable number of PCNA positive cells in high grade dysplasia and a variable amount of PCNA positive cells in the others groups. In addition, there was an overlap in the number of positive cases between low grade dysplasia (30%), indefinite (33%) and negative (34%). Therefore, the assessment of S-phase cells correlated with the degree of dysplasia seems to be of limited practical use. Cell proliferation is probably affected by many factors and mainly inflammation.