Endoscopic imaging identifies most BE patients with early neoplasia
MedWire News: Stepwise four-quadrant biopsies (4QBs) are unnecessary for detection of early neoplasias in Barrett's esophagus (BE) patients attending specialized high-volume centers with permanent quality control, say researchers.
However, outside this setting they suggest 4QBs should be carried out in addition to standard guided biopsies to ensure detection of invisible high-grade intraepithelial neoplasias (HGINs) or early carcinomas (ECs).
Juergen Pohl (Dr Horst Schmidt Klinik, Wiesbaden, Germany) and colleagues assessed the rate of HGINs/ECs that were not visible by enhanced visualization high-resolution endoscopy plus acetic acid chromoendoscopy in 701 consecutively enrolled BE patients, but were picked up by 4QBs.
Overall, 406 patients had a previous history of HGINs/ECs and were considered to be high-risk and 295 patients did not and were considered to be low-risk for developing further HGINs/ECs.
In total, 459 targeted endoscopic biopsies were carried out in 293 of the 701 patients who had visible mucosal abnormalities, while the other 408 had no visible mucosal irregularities and so did not undergo targeted biopsies. For comparison purposes, 5485 4QBs were carried out in 699 of the 701 patients on normal-appearing Barrett's mucosa.
Pohl and team detected 132 HGIN/EC lesions in 92 patients, all of whom were in the high-risk group.
The patient-related sensitivity and specificity for detection of HGIN/EC lesions using targeted biopsy were 96.7% and 66.5%, respectively, with positive and negative predictive values of 30.4% and 99.3%, respectively.
Only three additional patients with hidden HGINs/ECs were identified on 4QB endoscopy compared with targeted biopsy, again in the high-risk rather than the low-risk group.
The researchers conclude in the American Journal of Gastroenterology: "Sophisticated endoscopic imaging allows for reliable identification of patients with neoplasias by a directed biopsy approach and minimizes the additional value of 4QB."
They add: "In high-volume centers with implemented quality control, 4QB in Barrett's patients might be largely replaced by a TB approach that enables subsequent endoscopic treatment."
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By Helen Albert