Endoscopic optical coherence tomography is a high-resolution, cross-sectional tissue-imaging technique providing microscopic morphologic information.
Endoscopic optical coherence tomography should detect dysplasia in Barrett's epithelium, but this has not been established in a prospective blinded study.
Dr Gerard Isenberg and colleagues from Ohio evaluated the accuracy of endoscopic optical coherence tomography for the diagnosis of dysplasia with Barrett's esophagus.
A 2.4-mm diameter endoscopic optical coherence tomography probe was modified for use with a cap-fitted, 2-channel endoscope.
Pairs of endoscopic optical coherence tomography image streams and jumbo biopsy specimens were obtained.
|Specificity was 82% and positive predictive value was 53%|
Endoscopy procedures were performed by 4 endoscopists who separately reviewed the endoscopic optical coherence tomography digital images.
The digital images were investigated for the absence or the presence of dysplasia for each biopsy specimen obtained.
The endoscopists were blinded to the interpretation of the pathology.
An experienced pathologist blinded to the endoscopic/endoscopic optical coherence tomography findings evaluated each biopsy.
This blinded pathologist evaluated the biopsies for the absence or the presence of dysplasia.
The researchers included adult patients with documented Barrett's esophagus greater than 2 cm.
The main outcome measurement was the accuracy of endoscopic optical coherence tomography in the detection of dysplasia with Barrett's.
The researchers obtained a total of 314 usable endoscopic optical coherence tomography image stream/biopsy pairs in 33 patients.
By using histology as the standard, the performance of endoscopic optical coherence tomography had a 68% sensitivity.
The team found that specificity was 82% and positive predictive value was 53%.
The researchers also noted that negative predictive value was 89%, with a 78% diagnostic accuracy.
Diagnostic accuracy for the 4 endoscopists ranged from 56% to 98%.
The team reported that limitations of the study were the variability in endoscopists' accuracy rates.
Other limitations included difficulty in real-time interpretation, and the need for refined criteria of dysplasia by endoscopic optical coherence tomography imaging.
Dr Isenberg's team concluded, “The current endoscopic optical coherence tomography system has an accuracy of 78% for the detection of dysplasia in patients with Barrett's esophagus.”
“Endoscopic optical coherence tomography could be used to target biopsies to areas of Barrett's epithelium with a higher probability for the presence of dysplasia.”
“However, further modifications, including increased resolution and identification of further potential optical coherence tomography characteristics of dysplasia, are needed before endoscopic optical coherence tomography can be used clinically.”