Canto M I, Setrakian S, Petras R E, Blades E, Chak A, Sivak M V
Division of Gastroenterology, University Hospitals of Cleveland-Case Western Reserve University, Ohio, USA.
Gastrointest Endosc. 1996 Jul;44(1):1-7. doi: 10.1016/s0016-5107(96)70221-3.
Specialized columnar epithelium in Barrett's esophagus resembles gastric intestinal metaplasia, which selectively stains with methylene blue.
We prospectively evaluated the safety, accuracy, reproducibility, cost, and diagnostic yield of methylene blue-directed biopsy in detecting specialized columnar epithelium and dysplasia in Barrett's esophagus. We performed upper endoscopy with methylene blue-directed biopsy and obtained 236 large cup biopsy specimens (145 stained, 91 unstained) from 14 patients with Barrett's esophagus of any length (Group 1) and 12 control patients. Biopsy specimens were independently examined by two pathologists unaware of the endoscopic results.
Methylene blue stained specialized columnar epithelium in 18 of the 26 patients, including those with intramucosal carcinoma (1), high-grade dysplasia (1), and indefinite/low-grade dysplasia (6). Methylene blue staining pattern, which was focal in 72% and diffuse in 28% of patients, was reproduced in 8 patients who had repeat staining within 4 weeks. The overall accuracy of methylene blue staining for detecting specialized columnar epithelium was 95%. The diagnostic yield of methylene blue staining for specialized columnar epithelium in "control" patients was 42%. The risk for dysplasia in stained biopsy specimens was greater than in unstained ones (odds ratio 17.7, p = .0004).
Methylene blue mucosal staining is a safe, inexpensive, reproducible, and highly accurate method of diagnosing specialized columnar epithelium in Barrett's esophagus.
巴雷特食管中的特殊柱状上皮类似于胃肠化生，可被亚甲蓝选择性染色。
我们前瞻性评估了亚甲蓝引导活检在检测巴雷特食管中特殊柱状上皮和发育异常方面的安全性、准确性、可重复性、成本及诊断率。我们对患者进行了亚甲蓝引导活检的上消化道内镜检查，从14例不同长度巴雷特食管患者（第1组）和12例对照患者中获取了236个大杯状活检标本（145个染色，91个未染色）。活检标本由两名不知内镜检查结果的病理学家独立检查。
26例患者中有18例的特殊柱状上皮被亚甲蓝染色，包括那些患有黏膜内癌（1例）、高级别发育异常（1例）和不确定/低级别发育异常（６例）患者。亚甲蓝染色模式在72%的患者中为局灶性，28%为弥漫性，8例在4周内重复染色的患者中得到了重现。亚甲蓝染色检测特殊柱状上皮的总体准确率为95%。“对照”患者中亚甲蓝染色检测特殊柱状上皮的诊断率为42%。染色活检标本中发育异常的风险高于未染色标本（优势比17.7，p = .0004）。
亚甲蓝黏膜染色是诊断巴雷特食管中特殊柱状上皮的一种安全、廉价、可重复且高度准确的方法。
