QUANTITATIVE FLUORESCENCE IMAGE-ANALYSIS OF DNA CONTENT AND NUCLEAR MORPHOLOGY ON ESOPHAGEAL BALLOON CYTOLOGY SMEARS AND SUBSEQUENT DEVELOPMENT OF ESOPHAGEAL AND GASTRIC CARDIA CANCER IN LINXIAN, CHINA

The highest incidences of esophageal and gastric cardia cancer in the world occur in northern China, Chinese scientists have developed esoph ageal balloon cytology screening to detect these cancers, but traditio nal cytology is sometimes inadequate to find some early, curable lesio ns, Several studies suggest that quantitative fluorescence image analy sis (QFIA) of DNA ploidy and nuclear morphology may be able to improve upon traditional cytology results, In October 1987, esophageal balloo n cytology was performed on 1331 adults in Linxian, China, and all sam ples were evaluated both by traditional cytology and QFIA, From 1987 t o May 1991, 62 new squamous esophageal cancers and 44 new adenocarcino mas of the cardia were identified in this cohort, Proportional hazards models were used to evaluate the relationship of cytological diagnose s and six QFIA variables to subsequent cancer risk, These models showe d significant trends for increasing esophageal cancer risk, with incre asing values in five of the QFIA variables and with increasing severit y of the traditional cytological diagnoses, A comparison of models wit h only cytology variables versus models with both cytology and QFIA va riables indicated that the QFIA provided an important additional predi ctive value, Persons with both cytological dysplasia and high cellular DNA were 8 times more likely to develop esophageal cancer than were i ndividuals with neither of these conditions, For cardia cancer, associ ations between QFIA variables or cytological diagnoses and later cance r were more limited, This study suggests that the QFIA variables evalu ated here are independent predictors of squamous esophageal cancer and that combining QFIA with traditional cytology can improve prediction of esophageal cancer risk.