Brush Biopsy Ups the Detection of Barrett's Esophagus

Caroline Helwick

May 06, 2014

CHICAGO — The adjunctive use of computer-assisted esophageal brush biopsy can greatly enhance the detection of Barrett's esophagus, new research shows.

In a retrospective analysis, Wide Area Transepithelial Sampling biopsy with 3-dimensional analysis (WATS3D) enhanced the detection of Barrett's esophagus by 68.4%, said Seth Gross, MD, from the NYU Langone Medical Center in New York City.

The technology constructs a unique tissue specimen of the entire thickness of the epithelium, then uses computer-assisted 3D analysis to pinpoint potentially abnormal cells.

"The augmented detection rates are likely secondary to the sampling of a greater percentage of suspected Barrett's epithelium. Also, the enhanced review of available tissue minimizes the possibility of missing focal metaplasia or dysplasia," said Dr. Gross.

He and his colleagues conducted their study to estimate the yield of adjunctive WATS3D in multiple community-based gastroenterology practices.

Dr. Gross presented the results during a plenary session here at Digestive Disease Week 2014.

Current Gold Standard Leaves Much to Be Desired

"The gold standard for the diagnosis of Barrett's esophagus is the modified Seattle protocol, where 4-quadrant forceps biopsies are taken at least every 2 cm throughout the Barrett's esophagus segment," said Dr. Gross. However, "adherence to the Seattle protocol is low in the community setting and, even if the Seattle protocol is followed, 94% to 96% of the mucosa is not sampled."

WATS3D was "developed to overcome the sampling limitations of the 4-quadrant biopsy protocol," he reported. It yields a specimen that is a disaggregated combination of intact tissue fragments, cell clusters, and individual cells. The examination of this complex tissue sample is aided by a multiple-focal plane, neural network-based, computer-assisted scan of each slide. These abnormal cells are presented on a video monitor to a pathologist, he explained.

Study Details

Study investigators retrospectively reviewed prospectively collected data, from 28 community-based gastroenterologists, for patients with gastroesophageal reflux disease, possible Barrett's esophagus, or proven Barrett's esophagus who underwent upper endoscopy.

WATS3D was obtained using the standard 2-brush biopsy (EndoCDx, CDx Diagnostics). After the brush biopsy but during the same endoscopy, additional forceps biopsies were obtained.

Brush and forceps samples were evaluated by trained gastrointestinal pathologists at a central laboratory.

Most patients underwent endoscopy for the evaluation of gastroesophageal reflux disease. In 80% of cases, the length of suspected Barrett's esophagus was less than 3 cm. Mean age of the patients was 55 years.

 
In the hands of the community gastroenterologist, this relatively simple technique can enhance the ability to diagnose Barrett's.
 

A total of 2498 sets of specimens were analyzed.

Forceps biopsy identified Barrett's esophagus in 377 cases and adjunctive WATS3D identified an additional 258 cases (15% vs 25%). The increased diagnostic sampling yield with WATS3D was 68.4%.

Of the Barrett's esophagus cases identified, forceps biopsy identified 17 with dysplasia and adjunctive WATS3D identified and additional 10 cases of dysplasia and 1 case of cancer missed on forceps biopsy. The increased dysplasia/neoplasia detection with WATS3D was 64.7%.

"This multicenter community-based trial demonstrates the feasibility of the use of WATS3D in everyday endoscopic practice," Dr. Gross said. "It also shows that the widespread use of WATS3D in community-based gastroenterology practices identifies dysplasia missed by forceps biopsy, leading to improved care for these patients."

"In the hands of the community gastroenterologist, this relatively simple technique can enhance the ability to diagnose Barrett's, and more importantly, to diagnose Barrett's dysplasia," said session comoderator Kenneth McQuaid, MD, professor of medicine at the University of California, San Francisco.

"I thought this was very exciting, and I would be interested in knowing what the technology will cost," he told Medscape Medical News. "The focus so far has been on using imaging techniques, such as narrow-band imaging, and targeting random biopsies. Whether this could supplant these will be an interesting question."

Dr. Gross reports participating in advisory committees or review panels for EndoCdx, and consulting for Olympus America, CSA, Cook, and Given. Dr. McQuaid has disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2014. Abstract 371. Presented May 5, 2014.

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