Suspicious-appearing Epithelial Glands on Volumetric Laser Endomicroscopy Predict the Presence of Dysplasia During Surveillance of Barrettʼs Esophagus

Abstract

Introduction: Epithelial dysplasia (ED) within Barrett's esophagus (BE) increases the risk of progression to adenocarcinoma. Traditional surveillance using 4-quadrant forceps biopsies every 1-2 cm leaves most tissue unsampled, decreasing diagnostic accuracy. Alternate sampling methods and advanced imaging techniques, which evaluate a greater percentage of tissue, may address this deficiency. Volumetric Laser Endomicroscopy (VLE) provides real-time cross-sectional esophageal imaging to a resolution of 7 microns and a depth of 3 mm. Suspicious-appearing glands (SG) within BE epithelium may predict ED. Our aim was to evaluate whether the number of SG within a BE segment, and/or within an area of concern (AOC), predicts the presence of ED. Methods: All endoscopies performed between 3/2015 and 1/2017 for inspection of non-treated BE by a single endoscopist with expertise in VLE interpretation were included. Demographics and BE-related results, including Prague scores, number of SG within each AOC, and SG characteristics (shape, presence of necrosis) were recorded, along with the highest dysplasia grade from all tissue sampled. Findings were deidentified and aggregated for analysis. Results: A total of 127 cases met inclusion criteria. Mean Prague scores were C=1.48 cm (0-17 cm), M=2.83 cm (0-18 cm). Of these, 37 patients (29%) had dysplasia confirmed on pathology. In non-dysplastic cases, SG were absent in 60% (53/90), whereas SG were found in 78% (29/37) of dysplastic cases. The relative risk for dysplasia with SG present was 3.35 (95% CI 1.66-6.75, P=0.0007), while the negative predictive value for dysplasia with SG absent was 86.9% (95% CI 77.8%-92.6%). The likelihood of finding dysplasia increased based on the total number of SG present in a BE segment (12.5% with 1 SG, 64.7% if 10+ SG), as did the number of SG within a single AOC (39.2% with 1-2 SG, 74.1% with 6+ SG). Specific characteristics of each SG did not affect likelihood of dysplasia. Conclusion: These results suggest the presence of SG on a VLE scan is strongly associated with dysplastic findings on biopsy. Increased numbers of SG, both overall and within a specific AOC, appear to increase the likelihood of confirming dysplasia as well. Combined with other VLE features such as layering effacement and hyperscattering changes, the presence of SG may improve risk stratification of BE surveillance patients. Further research on biopsy-correlated datasets is necessary to identify the diagnostic accuracy of these VLE features.Table: Table. Likelihood of Finding Dysplasia on Biopsy Based on Total Number of Suspicious-Appearing Epithelial GlandsTable: Table. Likelihood of Finding Dysplasia on Biopsy Based on Maximum Number of Suspicious-Appearing Epithelial Glands Within An Area of Concern