Cytometric DNA analysis of Barrett's mucosa

Background: Barrett's esophagus predisposes to cancer development. The diag nosis of dysplastic precursor lesions is impaired by problems of subjectivi ty. In the present study, DNA ploidy results of patients with Barrett's eso phagus were related to the grade of dysplasia and to the progress of the di sease. Patients and Methods: In 61 patients with Barrett's esophagus, DNA ploidy w as determined by image cytometry on imprints. All biopsies (n = 145) were h istologically examined for dysplasia distinguishing between low- and high-g rade dysplasia, and dysplasia-negative. Results: A significant correlation (p < 0.001) between DNA ploidy and the g rade of dysplasia was found, with 81% euploid DNA results in biopsies negat ive for dysplasia and 86% abnormal DNA patterns in biopsies with high-grade dysplasia. The subgroup of low-grade dysplasia showed a heterogeneous DNA ploidy. It is important to note that nearly 20% of biopsies classified dysp lasia-negative contained abnormal single cells or abnormal stemlines regard ing DNA content. In several cases, suspect DNA results caused a modified re classification of dysplasia, and there were casts in which patients negativ e for dysplasia bur positive for abnormal DNA ploidy developed dysplasia la ter on. Conclusion: In patients with Barrett's esophagus, DNA ploidy by image cytom etry is a suitable additive method for histological evaluation of dysplasia . It seems to be helpful in identifying patients at risk, perhaps before th e development of clear dysplasia.