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The effect of reactive atypia/inflammation on the laser‐induced fluorescence diagnosis of non‐dysplastic Barrett's esophagus
Author(s) -
Panjehpour Masoud,
Overholt Bergein F.,
VoDinh Tuan,
Coppola Domenico
Publication year - 2012
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.22033
Subject(s) - barrett's esophagus , atypia , dysplasia , medicine , esophagus , biopsy , pathology , esophagogastroduodenoscopy , gastroenterology , inflammation , endoscopy , adenocarcinoma , cancer
Background and Objectives Differential Normalized Fluorescence (DNF) technique has been used to distinguish high‐grade dysplasia from non‐dysplastic Barrett's esophagus. This technology may assist gastroenterologists in targeting biopsies, reducing the number of biopsies using the standard protocol. In the presence of reactive atypia/inflammation, it becomes difficult for the pathologist to differentiate non‐dysplastic Barrett's esophagus from Barrett's esophagus with low‐grade dysplasia. Before DNF technique may be used to guide target biopsies, it is critical to know whether reactive atypia/inflammation in non‐dysplastic Barrett's may result in false positives. This study was conducted to determine whether DNF technique is adversely affected by the presence of reactive atypia/inflammation in non‐dysplastic Barrett's esophagus resulting in false positives. Study Design/Materials and Methods Four hundred ten‐nanometer laser light was used to induce autofluorescence of Barrett's mucosa in 49 patients. The clinical study included 37 males and 12 females. This was a blinded retrospective data analysis study. A total of 303 spectra were collected and matched to non‐dysplastic Barrett's biopsy results. One hundred seventy‐five spectra were collected from areas with a pathology of non‐dysplastic Barrett's esophagus with reactive atypia/inflammation. One hundred twenty‐eight spectra were collected from areas with non‐dysplastic Barrett's esophagus without reactive changes/inflammation. The spectra were analyzed using the DNF Index at 480 nm and classified as positive or negative using the threshold of −0.75 × 10 −3 . Results Using DNF technique, 92.6% of non‐dysplastic samples with reactive atypia/inflammation were classified correctly (162/175). 92.2% of non‐dysplastic samples without reactive atypia/inflammation were classified correctly (118/128). Comparing the ratios of false positives among the two sample groups, there was not a statistically significant difference between the two groups. Conclusion Using DNF technique for classification of non‐dysplastic Barrett's mucosa does not result in false‐positive readings due to reactive atypia/inflammation. Target biopsies guided by DNF technique may drastically reduce the number of pinch biopsies using the standard biopsy protocol. Lasers Surg. Med. 44: 390–396, 2012. © 2012 Wiley Periodicals, Inc.