ENDOSCOPIC FLUORESCENCE DETECTION OF HIGH-GRADE DYSPLASIA IN BARRETTS-ESOPHAGUS

Background & Aims: Early detection and treatment of esophageal cancer in Barrett's esophagus may improve patient survival if dysplasia is ef fectively detected at endoscopy. Typically, four-quadrant pinch biopsy specimens are taken at 2-cm intervals. This study was conducted to de termine whether laser-induced florescence spectroscopy could be used t o detect high-grade dysplasia in patients with Barrett's esophagus. Me thods: Four hundred ten-naonometer laser light was used to induce auto fluorescence of Barrett's mucosa in 36 patients. The spectra were anal yzed using the differential normalized fluorescence (DNF) index techni que to differentiate high-grade dysplasia from either low-grade or non dysplastic mucosa. Each spectrum was classified as either premalignant or benign using two different DNF indices. Results: Analysis of the f luorescence spectra from all patients collectively using the DNF inten sity at 480 nm (DNF480) index showed that 96% of nondysplastic Barrett 's esophagus samples were classified as benign, all low-grade dysplasi a samples as benign, 90% of high-grade dysplasia samples as premaligna nt, and 28% of low-grade with focal high-grade dysplasia samples as pr emalignant. Using the two DNF indices concurrently, all patients with any high-grade dysplasia were classified correctly. Conclusions: Laser -induced fluorescence spectroscopy has great potential to detect high- grade dysplasia in Barrett's esophagus when using the DNF technique.