Videoconference microscopy is a reliable alternative to conventional microscopy in the evaluation of Barrett’s esophagus: Zooming into a new era

2021 ◽  
Author(s):  
Page Axley ◽  
Rachel Mitchell ◽  
Leona Council ◽  
Chirag Patel ◽  
Jessica Tracht ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Gastroesophageal Junction ◽  
Weighted Kappa ◽  
Observer Agreement ◽  
Histological Evaluation ◽  
Low Grade ◽  
Good Reliability ◽  
Conventional Microscopy

Abstract Telepathology, practicing pathology from a distance, allows experts to review cases without the need to transfer glass slides. Due to significant intra- and inter-observer variabilities in the histological evaluation of Barrett’s esophagus (BE), current guidelines recommend expert consultation in cases of dysplasia. We aimed to determine whether telepathology using microscope videoconferencing can be reliably used for evaluation of BE. Biopsies from 62 patients with endoscopic findings of salmon colored mucosa extending ≥1 cm proximal to the gastroesophageal junction were randomly selected to represent benign esophagus, non-dysplastic BE, low-grade dysplasia, high-grade dysplasia, and adenocarcinoma. Three gastrointestinal-trained pathologists reviewed the cases via videoconference microscopy followed by conventional microscopy. Intra-observer and pairwise inter-observer agreements between the conventional microscopy and videoconference methodologies were calculated for each of the three pathologists using Fleiss-Cohen weighted kappa (K) analysis. The intra-observer agreement for each pathologist’s assessment of videoconference microscopy and glass slide readings showed very good reliability (K = 0.94, 95% confidence interval = 0.89–0.99; 0.88, 95% confidence interval = 0.79–0.98; 0.93, 95% confidence interval = 0.90–0.97). Mean pairwise inter-observer agreement was 0.90 for videoconference and 0.91 for conventional microscopy. Diagnosis and grading of BE using videoconference microscopy show similar reliability as conventional microscopy. Based on our findings, we propose that videoconferencing pathology is a valid instrument for evaluating BE.

Digital microscopy as valid alternative to conventional microscopy for histological evaluation of Barrett's esophagus biopsies

2017 ◽  
Vol 30 (11) ◽  
pp. 1-7 ◽  
Author(s):  
M. J. van der Wel ◽  
L. C. Duits ◽  
C. A. Seldenrijk ◽  
G. J. Offerhaus ◽  
M. Visser ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Histological Evaluation ◽  
Digital Microscopy ◽  
Conventional Microscopy

scholarly journals Columnar metaplasia and Barrett’s esophagus: morphological heterogeneity and immunohistochemical phenotype

2019 ◽  
pp. 77-83
Author(s):  
L.M. Mikhaleva ◽  
K.S. Voytkovskaya ◽  
E.D. Fedorov ◽  
N.A. Gracheva ◽  
A.E. Birukov ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Gastroesophageal Junction ◽  
Immunohistochemical Analysis ◽  
Low Grade ◽  
Neoplastic Progression ◽  
Morphological Heterogeneity ◽  
Reactive Changes ◽  
Premalignant Condition ◽  
Columnar Metaplasia

Barrett’s esophagus (BE) is a pathologically confirmed intestinal metaplasia (CM) of the distal esophagus. BE is recognized as a potential complication of gastroesophageal reflux disease (GERD) and a premalignant condition with a high risk of neoplastic progression. The aim of this study was to compare the morphology of biopsied BE segments and CM segments extending < 1 cm and > 1 cm above the gastroesophageal junction (GEJ), as well as to perform the immunohistochemical analysis of biopsies with BE and CM > 1 cm above GEJ with or without dysplasia. The study recruited 92 patients with GERD: 42 patients with BE, 24 patients with CM > 1 cm above GEJ (С0М1.5–С13M14) and 26 patients with CM < 1 cm above GEJ (С0М0.3–0.8). Comparative analysis of tissue morphology revealed an association between the reactive changes in the epithelium and the severity of esophagitis in all groups. Reactive changes were detected significantly more often in BE segments than in CM segments > 1 cm (Mann-Whitney U, p < 0.05). Eight patients with BE (19.05%) were found to have low-grade dysplasia. One patient with CM > 1 cm above GEJ (4.2%) had high-grade dysplasia with cardiac-type metaplasia and immunohistochemical features of submorphological enteralization. Immunohistochemical testing for the intestinal and gastric markers of cell differentiation revealed the signs of submorphological enteralisation in all esophageal specimens with cardiac and fundic type metaplasia and in the specimens with BE in the areas lacking goblet cells.

scholarly journals Accuracy of probe-based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett’s esophagus

2018 ◽  
Vol 06 (04) ◽  
pp. E414-E420 ◽  
Author(s):  
Tilak Shah ◽  
Robert Lippman ◽  
Divyanshoo Kohli ◽  
Pritesh Mutha ◽  
Sanjeev Solomon ◽  
...  
Keyword(s):  
Real Time ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Eradication Therapy ◽  
Observer Agreement ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Lower Sensitivity ◽  
Low Grade ◽  
Esophageal Mucosa

Abstract Background For surveillance of Barrett’s esophagus (BE), the current standard of random 4-quadrant biopsies misses 10 – 50 % of esophageal neoplasms, and does not permit real-time decision-making. Probe-based confocal laser endomicroscopy (pCLE) permits real-time in vivo histologic assessment of esophageal mucosa during upper endoscopy. Prospective studies comparing the accuracy of pCLE to 4-quadrant biopsies in routine clinical practice are lacking. Methods Consecutive patients with BE underwent high definition white light and narrow-band imaging followed by pCLE and targeted biopsy or mucosal resection. Four-quadrant biopsies were obtained during the same session. Baseline variables, real-time pCLE interpretation, and histology results were prospectively recorded. Blinded expert review of pCLE sequences and histology specimens was performed. A sample size of 64 patients was calculated a priori based on 3 % estimated prevalence of high grade dysplasia (HGD) or cancer. Results In total, 66 patients were included in the study. The prevalence of HGD or cancer was 4.55 %. Both real-time and blinded pCLE correctly identified all cases of cancer. For the primary outcome, real-time pCLE was 98 % specific but only 67 % sensitive for HGD/cancer compared to non-blinded pathologist interpretation. For HGD and cancer, inter-observer agreement was substantial between real-time and blinded endomicroscopists (kappa = 0.6). pCLE identified dysplasia in 75 % of cases where both blinded and unblinded pathology interpretation was low grade dysplasia. Conclusions pCLE demonstrates high specificity for detecting dysplasia and cancer, but lower sensitivity may limit its utility in routine BE surveillance. pCLE may have a role in confirming LGD in real-time before eradication therapy.

scholarly journals Esophageal abnormalities and the risk for gastroesophageal cancers—a histopathology-register-based study in Sweden

2022 ◽  
Author(s):  
Isabella Ekheden ◽  
Jonas F. Ludvigsson ◽  
Li Yin ◽  
Peter Elbe ◽  
Weimin Ye
Keyword(s):  
General Population ◽  
Confidence Interval ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Population Based ◽  
Low Grade ◽  
Gastric Cardia Adenocarcinoma ◽  
Increased Risk ◽  
Columnar Metaplasia

Abstract Background The poor survival of patients with gastroesophageal cancers may improve if additional esophageal precursor lesions to Barrett’s esophagus and squamous dysplasia are identified. We estimated the risk for gastroesophageal cancers among patients with various histopathological abnormalities in the esophagus, including Barrett’s esophagus, subdivided by histopathological types. Methods Histopathology data from esophageal biopsies obtained 1979–2014 were linked with several national population-based registers in Sweden. Patients were followed from 2 years after the first biopsy date until cancer, death, emigration, esophagectomy/gastrectomy or end of follow-up, 31st of December 2016, whichever came first. We estimated standardized incidence ratios (SIRs) as measures of relative risk with the Swedish general population as reference. Results In total 367 esophageal adenocarcinoma (EAC) cases were ascertained during 831,394 person-years of follow-up. The incidence rate (IR) for EAC was 0.1 per 1000 person-years for normal morphology, 0.2–0.5 for inflammatory changes, and 0.8–2.9 for metaplasia. The IR was 1.0 per 1000 person-years (95% confidence interval 0.7–1.3) among patients with non-dysplastic intestinal metaplasia, 0.9 (0.8–1.1) in non-dysplastic gastric/glandular metaplasia and 2.9 (2.0–4.2) among columnar metaplasia patients with low-grade dysplasia. The SIRs were 11.7 (95% confidence interval 8.6–15.5), 12.0 (10.0–14.2) and 30.2 (20.5–42.8), respectively. The SIRs for gastric cardia adenocarcinoma (GCA) were moderately elevated. Conclusions For the first time, we demonstrate that patients with esophageal inflammatory and other metaplastic abnormalities than Barrett’s esophagus have an increased risk of EAC and GCA compared to the general population. Moreover, patients with different histopathologic subtypes of Barrett’s esophagus have a comparable risk for EAC.

scholarly journals TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

2021 ◽  
Vol 09 (03) ◽  
pp. E348-E355
Author(s):  
David L. Diehl ◽  
Harshit S. Khara ◽  
Nasir Akhtar ◽  
Rebecca J. Critchley-Thorne
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Clinical Decision Making ◽  
Eradication Therapy ◽  
Low Risk ◽  
Management Approach ◽  
Low Grade ◽  
Management Decisions ◽  
The Impact

Abstract Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

Endoscopic Expert Revision of Previous Histological Confirmed Flat Low-Grade Dysplasia In Barrett’s Esophagus

2021 ◽  
Author(s):  
EA Nieuwenhuis ◽  
SN van Munster ◽  
BLAM Weusten ◽  
L Alvarez Herrero ◽  
A Bogte ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Low Grade ◽  
Low Grade Dysplasia
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