Endoscopic surveillance of Barrett's esophagus currently relies on multiple random biopsies.
This approach is time consuming, has a poor diagnostic yield, and significant interobserver variability.
Elastic scattering spectroscopy is a real time in vivo optical technique which detects changes in the physical properties of cells.
Dr Lovat and colleagues from England assessed the potential for elastic scattering to detect high grade dysplasia or cancer with Barrett's.
Elastic scattering spectroscopy measurements collected in vivo were matched with histological specimens taken from identical sites within Barrett's esophagus.
The research team reviewed all biopsies by 3 gastrointestinal pathologists.
|Elastic scattering spectroscopy detected high risk sites with 92% sensitivity|
The biopsies were defined as low risk if they were non-dysplastic or low grade dysplasia, and high risk if they detected high grade dysplasia or cancer.
The team used 2 different statistical approaches to validate the model.
A total of 181 matched biopsy sites from 81 patients, where histopathological consensus was reached, were analyzed.
The researchers reported that there was good pathologist agreement in differentiating high grade dysplasia and cancer from other pathology.
Elastic scattering spectroscopy detected high risk sites with 92% sensitivity and 60% specificity.
The team found that the technique differentiated high risk sites from inflammation with a sensitivity and specificity of 79%.
If used to target biopsies during endoscopy, the number of low risk biopsies taken would decrease by 60% with minimal loss of accuracy.
The researchers noted that a negative spectroscopy result would exclude high grade dysplasia or cancer with an accuracy of almost 100%.
Dr Lovat's team concludes, “These preliminary results show that elastic scattering spectroscopy has the potential to target conventional biopsies in Barrett's surveillance saving significant endoscopist and pathologist time with consequent financial savings.”
“This technique now requires validation in prospective studies.”