BARRETT-ESOPHAGUS WITH DYSPLASIA - FLOW CYTOMETRIC DNA ANALYSIS OF ROUTINE, PARAFFIN-EMBEDDED MUCOSAL BIOPSIES

Flow cytometric DNA ploidy analysis has been reported to be more objec tive and sensitive than morphologic evaluation as a surveillance metho d in patients with Barrett esophagus (BE) for the development and prog ression of precancerous lesions. Such analyses are typically performed using fresh samples that require a separate or ''jumbo'' biopsy, are prone to false DNA aneuploidy if not promptly processed, and do not al low for retrospective studies. The feasibility of performing flow cyto metric DNA analysis on paraffin-embedded biopsies was studied to circu mvent some of these problems using 12 squamous esophageal mucosa with inflammation and 58 RE cases showing varying degrees of dysplasia. Amo ng the BE cases, 12 had no dysplasia, 20 were indefinite for dysplasia , 14 had low grade dysplasia, and 12 had high grade dysplasia. Satisfa ctory histograms were obtained in 86% of the analyzed samples. Among c ases with adequate histograms, DNA aneuploidy was identified in 77% wi th high grade dysplasia, 16% with low grade dysplasia, 23% of indefini te for dysplasia, and 0% without dysplasia. One of the esophagitis sam ples was also DNA aneuploid. Correlation of DNA aneuploidy and degree of dysplasia is highly significant (P = .001). The authors have demons trated that routinely processed paraffin-embedded biopsies can be used for flow cytometric ploidy analysis. DNA aneuploidy was highly correl ated with degree of dysplasia and serves as a quantitative prognostic indicator for prospective as well as retrospective studies of tile evo lution of BE to carcinoma.