Clinical Gastroenterology and Hepatology
Volume 4, Issue 1 , Pages 38-43, January 2006

Optical Coherence Tomography to Identify Intramucosal Carcinoma and High-Grade Dysplasia in Barrett’s Esophagus

  • John A. Evans

      Affiliations

    • Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • John M. Poneros

      Affiliations

    • Department of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • ,
  • Brett E. Bouma

      Affiliations

    • Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Jason Bressner

      Affiliations

    • Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Elkan F. Halpern

      Affiliations

    • Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Milen Shishkov

      Affiliations

    • Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Gregory Y. Lauwers

      Affiliations

    • Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Mari Mino–Kenudson

      Affiliations

    • Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Norman S. Nishioka

      Affiliations

    • Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston
    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
    • ,
  • Guillermo J. Tearney

      Affiliations

    • Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
    • Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston
    • Corresponding Author InformationAddress requests for reprints to: Guillermo J. Tearney, MD, PhD, Associate Professor of Pathology, Harvard Medical School, Wellman Center for Photomedicine, Massachusetts General Hospital, 40 Blossom Street, BAR 703, Boston, Massachusetts 02114; fax: (617) 726-4103

published online 24 October 2005.

Background & Aims: Optical coherence tomography (OCT) is an optical technique that produces high-resolution images of the esophagus during endoscopy. OCT can distinguish specialized intestinal metaplasia (SIM) from squamous mucosa, but image criteria for differentiating intramucosal carcinoma (IMC) and high-grade dysplasia (HGD) from low-grade dysplasia (LGD), indeterminate-grade dysplasia (IGD), and SIM without dysplasia have not been validated. The purpose of this study was to establish OCT image characteristics of IMC and HGD in Barrett’s esophagus. Methods: Biopsy-correlated OCT images were acquired from patients with Barrett’s esophagus undergoing endoscopic surveillance. Two pathologists rendered consensus diagnoses of the biopsy specimens. A blinded investigator reviewed the biopsy-correlated OCT images and scored each for surface maturation and gland architecture. For each image the scores were summed to determine an OCT “dysplasia index.” Results: A total of 177 biopsy-correlated images were analyzed. The corresponding histopathology diagnosis was IMC/HGD in 49 cases, LGD in 15, IGD in 8, SIM in 100, and gastric mucosa in 5. A significant relationship was found between a histopathologic diagnosis of IMC/HGD and scores for each image feature (dysplasia index [Spearman correlation coefficient, r = 0.50, P < .0001], surface maturation [r = 0.48, P < .0001], and gland architecture [r = 0.41, P < .0001]). When a dysplasia index threshold of ≥2 was used, the sensitivity and specificity for diagnosing IMC/HGD were 83% and 75%, respectively. Conclusions: An OCT image scoring system based on histopathologic characteristics has the potential to identify IMC and HGD in Barrett’s esophagus.

Abbreviations used in this paper:  BE, Barrett’s esophagus , HGD, high-grade dysplasia , IGD, indeterminate-grade dysplasia , IMC, intramucosal carcinoma , LGD, low-grade dysplasia , OCT, optical coherence tomography , SIM, specialized intestinal metaplasia

 

 Supported in part by the National Institutes of Health (NIH R01 CA 103769-03) and the Center for the Integration of Medicine and Innovative Technology (development of the imaging platform).

PII: S1542-3565(05)00746-9

Clinical Gastroenterology and Hepatology
Volume 4, Issue 1 , Pages 38-43, January 2006