Discrimination of esophageal dysplasia with progression and nonprogression- High-resolution image analysis for surrogate end point biomarkers

OBJECTIVE: To detect textural nuclear features correlated with nonprogressi on and progression in esophageal dysplasia. STUDY DESIGN: Asymptomatic adults from Heshun Commune, Linxian County, Chin a were examined with a balloon sampler in 1983 fifty cases of moderate esop hageal dysplasia and 68 cases of mim were selected for study. By means of a n Axiomat microscope equipped with a TV camera, 100 visually normal interme diate squamous cell nuclei per specimen were randomly measured from routine ly Papanicolaou-stained slides. RESULTS: Of 50 esophageal moderate dysplasia cases, 24 and 7 progressed to carcinoma within three and nine years, respectively The other 19 cases rema ined stable or regressed to normal and were used as the control group. By m eans of chromatin features, correct specimen classification rates of 79.2% (19/24), 73.7% (14/19), 85.5% (6/7) and 84.2% (16/19) were achieved, respec tively (P <.001). Of 68 cases classified as mild dysplasia, IG, 13 and 12 p rogressed to carcinoma within three, five and nine years, respectively, nle other 27 cases remained stable or regressed to normal and were used as the control group. The correct specimen classification rates were 93.8% (15/16 ), 88.9% (24/27), 69.2% (9/13), 74.1% (20/27), 83.3% (10/12) and 77.8% (21/ 27), respectively, using chromatin features of the nuclei (P<.001). CONCLUSION: In this study, nuclear chromatin features measured by high-reso lution image analysis could sufficiently well forecast the outcome of preca ncerous lesions and discriminate precancerous lesions with progression and nonprogression. It also can be employed as surrogate end point biomarkers i n clinical chemoprevention trials. Stoichiometric staining and standard pre parations should increase the correct classification rates in further studi es.