Evaluation of endocytoscopy in the surveillance of patients with Barrett’s esophagus

Background and study aims: Surveillance for patients with Barrett’s esophagus is time consuming and subject to sampling error. Guided biopsies from neoplastic areas invisible on conventional endoscopy may increase effectiveness of surveillance examination. We assessed the accuracy of endocytoscopy in correlation with histology.

Methods: We analyzed 166 biopsy sites from 16 patients (13 male, mean age 62.1 years), without visible lesions, who presented for Barrett surveillance. Endocytoscopy images were recorded from pre-marked areas in the Barrett’s segment using magnification × 1125 or × 450. Biopsies were taken from the same area to allow precise comparison with histology. Image sequences of each area were individually and blindly reviewed by a pathologist and a gastroenterologist. Major outcome variables included image quality, identification of neoplastic characteristics, and accuracy of endocytoscopy.

Results: Adenocarcinoma was histologically diagnosed in 4.2 % of biopsy sites, high grade intraepithelial neoplasia (HGIN) in 16.9 %, and low grade intraepithelial neoplasia (LGIN) in 12.1 %. Adequate assessment of endocytoscopy images was impossible in 49 % of the pre-marked areas with magnification × 450 and in 22 % with magnification × 1125. At most, 23 % of images with lower magnification were interpretable to identify characteristics of neoplasia, and 41 % with higher magnification. Interobserver agreement was fair at best (kappa from < 0 to 0.45). Positive and negative predictive values for HGIN or cancer were 0.29 and 0.87, respectively, for magnification × 450 and 0.44 and 0.83, respectively, for magnification × 1125.

Conclusion: When not supported by macroscopic evidence, endoscopic histology using endocytoscopy lacks sufficient image quality to be currently of assistance in identifying neoplastic areas.

References

• 1 Brown L M, Devesa S S. Epidemiologic trends in esophageal and gastric cancer in the United States.  Surg Oncol Clin N Am. 2002;  11 235-256
• 2 El-Serag H B. The epidemic of esophageal adenocarcinoma.  Gastroenterol Clin N Am. 2002;  31 421-440, viii
• 3 Pohl H, Welch H G. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.  J Natl Cancer Inst. 2005;  97 142-146
• 4 Dumonceau J M, Giostra E, Genta R. et al . In vivo microscopic examination of the esophagus for the detection of cancer before liver transplantation in patients with alcoholic cirrhosis.  Endoscopy. 2006;  38 282-284
• 5 Kiesslich R, Gossner L, Goetz M. et al . In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy.  Clin Gastroenterol Hepatol. 2006;  4 979-987
• 6 Sasajima K, Kudo S E, Inoue H. et al . Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system.  Gastrointest Endosc. 2006;  63 1010-1017
• 7 Inoue H, Kudo S E, Shiokawa A. Technology insight: laser-scanning confocal microscopy and endocytoscopy for cellular observation of the gastrointestinal tract.  Nat Clin Pract Gastroenterol Hepatol. 2005;  2 31-37
• 8 Eberl T, Jechart J, Golczyk M. et al . Can endo-cytoscope system (ECS) predict histology in neoplastic lesions [abstract]?.  Gastrointest Endosc. 2006;  63 AB88
• 9 Hamilton S R, Aaltonen L A. (eds) .Pathology and genetics of tumours of the digestive system. World Health Organization classification of tumors. Lyon; International Agency for Research on Cancer Press 2000
• 10 Geisinger K R, Teot L A, Richter J E. A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett’s esophagus.  Cancer. 1992;  69 8-16
• 11 Inoue H, Sasajima K, Kaga M. Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial.  Endoscopy. 2006;  38 891-895
• 12 Kumagai Y, Inoue H, Nagai K. et al . Magnifying endoscopy, stereoscopic microscopy, and the microvascular architecture of superficial esophageal carcinoma.  Endoscopy. 2002;  34 369-375
• 13 Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in vivo pathological diagnosis using an endocytoscopy system.  Endoscopy. 2004;  36 590-594
• 14 Inoue H, Kazawa T, Sato Y. et al . In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, “Endo-Cytoscopy system”.  Gastrointest Endosc Clin N Am. 2004;  14 589-594, x - xi
• 15 Sasajima K, Kudo S E, Inoue H. et al . Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system.  Gastrointest Endosc. 2006;  63 1010-1017
• 16 Kara M A, Bergman J J. Autofluorescence imaging and narrow-band imaging for the detection of early neoplasia in patients with Barrett’s esophagus.  Endoscopy. 2006;  38 627-631