Endoscopic detection of dysplasia in patients with Barrett's esophagus using light-scattering spectroscopy

Background & Aims: We conducted a study to assess the potential of light-sc attering spectroscopy (LSS), which can measure epithelial nuclear enlargeme nt and crowding, for in situ detection of dysplasia in patients with Barret t's esophagus, Methods: Consecutive patients with suspected Barrett's esoph agus underwent endoscopy and systematic biopsy, Before biopsy, each site wa s sampled by LSS using a fiberoptic probe. Diffusely reflected white light was spectrally analyzed to obtain the size distribution of cell nuclei in t he mucosal layer, from which the percentage of enlarged nuclei and the degr ee of crowding were determined, Dysplasia was assigned if more than 30% of the nuclei exceeded 10 mu m and the histologic findings compared with those of 4 pathologists blinded to the light-scattering assessment, The data wer e then retrospectively analyzed to further explore the diagnostic potential of LSS, Results: Seventy-six sites from 13 patients were sampled. All abno rmal sites and a random sample of nondysplastic sites were reviewed by the pathologists, The average diagnoses were 4 sites from 4 different patients as high-grade dysplasia (HGD), 8 sites from 5 different patients as low-gra de dysplasia (LGD), 12 as indefinite for dysplasia, and 52 as nondysplastic Barrett's, The sensitivity and specificity of LSS for detecting dysplasia (either LGD or HGD) were 90% and 90%, respectively, with all HGD and 87% of LGD sites correctly classified. Decision algorithms using both nuclear enl argement and crowding further improved diagnostic accuracy, and accurately classified samples into the 4 histologic categories. Conclusions: LSS can r eliably detect LGD and HGD in patients with Barrett's esophagus.