Diagnosis of Early Neoplasia in Barrett’s Mucosa Based on Changes in Surface Structure. Comparative Stereo-Microscopic and Histological Investigations in 600 Endoscopically Resected Specimens.

Abstract

In view of the rapidly increasing incidence of Barrett's carcinoma, a desirable aim would be to detect intraepithelial neoplasia and mucosal carcinoma via the endoscope. Where something new is growing, it should give rise to visible changes in surface structure, in particular, in the case of the early Barrett's neoplasia. The present study was carried out to investigate this hypothesis. A total of 600 formalin-fixed endoscopically resected specimens (317 patients) from Barrett's oesophagus were prospectively investigated by stereomicroscopy (magnification up to x 90). The surface structure was classified into regular (finely granulated or ridged gyriform) and irregular (coarsely granulated, polypoid elevated or depressed), and compared with the results of the histological evaluation. 88.5 % of the Barrett's carcinomas, and 76 % and 68 %, respectively, of the cases of high-grade and low-grade intraepithelial neoplasia were associated with an irregular surface structure. However, coarsely granulated mucosal surfaces, reflecting regenerative changes, were also found in 26 % of the cases of Barrett's mucosa without intraepithelial neoplasia. Despite formalin fixation, 68 - 88.5 % of the cases of early Barrett's neoplasia can be identified by stereo microscopy. This shows that high-resolution videoendoscopy or magnification endoscopy appears to be a highly suitable method for the targeted detection of early Barrett's neoplasia.