527 TissueCypher™ Barrett's Esophagus Assay for Risk Stratification of Barrett's Esophagus Patients With “Low Grade Crypt Dysplasia” on WATS3D® Brush

Abstract

INTRODUCTION: Barrett's Esophagus (BE) and progression into esophageal adenocarcinoma (EA) is a major cause of cancer-related morbidity and mortality in the United States. Surveillance of patients with non-dysplastic BE has encountered a subset of specimens termed low grade crypt dysplasia (BE-LGCD) through use of Wide Area Trans-Epithelial Sampling (WATS) brush. The natural history of BE-LGCD is not currently known. To better characterize the risk of progression from LGCD to EA, we utilized a TissueCypher BE analysis (a validated BE risk progression tool) to produce a comprehensive risk prediction for development of high-grade dysplasia (HGD) or EA in patients with BE. METHODS: We sampled 17 patients with a history of BE made via Esophagogastroduodenoscopy (EGD) biopsy with WATS brush samples displaying “LGCD” between July 01,2017 to July 01, 2018. Pathology slides collected via standard of care screening EGDs were sent to an affiliate laboratory for the TissueCypher BE analysis. TissueCypher categorized the risk of progression as either low (Risk score 0-< 5.5), Intermediate (5.5-< 6.4), and High (Risk score > 6.4) based on protein-based biomarkers. TissueCypher analysis generated an in-depth score analysis for risk of progression to EA. We used measures of central tendency to identify the risk of progression and studied identified risks of BE (BMI, smoking, age, gender, family history, GERD). We also used Regression Analysis and Kendall Tests to determine significance of these variables as well as their dependence on elevated risk. RESULTS: Of the 17 samples included, 5.8% represented female patients. The Mean age was 64.2 years. Mean risk of progression was overall low (Risk Score of 4.95, SD of 1.30). 100% of samples collected were from Caucasian patients. Increased segment length of BE, increased BMI, history of GERD or tobacco use, and family history of BE or EA did not correlate with increased risk of progression [Table 1]. BMI, smoking history, BE segment length, GERD history, as well as family history were not statistically dependent variables [Table 2]. CONCLUSION: Our data implies that BE-LGCD is not associated with increased risk of progression to EA. It mostly affects Caucasian males. Smoking, high BMI, segment length, history of GERD, and family history were not associated with increased risk of progression towards EA. Limitations to this study include a small sample size vs non-representative sample population. Future studies could identify progression of these patients.