Diagnosis of specialized intestinal metaplasia by optical coherence tomography

Background & Aims: Optical coherence tomography (OCT) is an imaging techniq ue that produces high-resolution cross-sectional images in vivo. The aim of this study was to establish the sensitivity and specificity of OCT for dia gnosing specialized intestinal metaplasia (SIM), Methods: OCT was used to i mage the stomach and esophagus of 121 patients. A total of 288 biopsy-corre lated OCT images were acquired. OCT criteria for SIM were formulated by ana lyzing 75 images of SIM. The SIM image criteria were retrospectively tested by applying them to images of gastric, squamous, SIM, and cardiac epitheli um. The criteria were then tested prospectively to determine the sensitivit y and specificity of OCT for diagnosing SIM. Results: OCT images of SIM are characterized by (1) absence of the layered structure of normal squamous e pithelium and the vertical "pit and crypt" morphology of gastric mucosa, (2 ) disorganized architecture with inhomogeneous tissue contrast and an irreg ular mucosal surface, and (3) presence of submucosal glands, These criteria were 100% sensitive and 93% specific for SIM when applied retrospectively and 97% sensitive and 92% specific when tested prospectively, Conclusions: OCT is highly sensitive and specific for SIM and may aid in the diagnosis a nd surveillance of this preneoplastic lesion.