Methylene blue staining of dysplastic and nondysplastic Barrett's esophagus: An in vivo and ex vivo study

Background and Study Aims: Methylene blue selectively stains specialized co lumnar epithelium in Barrett's esophagus with high accuracy. We prospective ly evaluated the methylene blue staining properties of dysplastic and nondy splastic Barrett's esophagus and the association of these properties with t he risk for dysplasia and cancer. Patients and Methods: In a ex vivo study, we mapped, photographed, and samp led esophagectomy specimens with high grade dysplasia and/or early adenocar cinoma before and after methylene blue staining. In a concurrent in vivo st udy, we performed methylene blue staining acid characterized methylene blue stain characteristics, Pathologists estimated the proportion of specialize d columnar epithelium in each specimen and graded dysplasia, Results: We examined 551 biopsies from 47 patients with biopsy-proven Barre tt's esophagus and 48 sections from five surgical specimens with Barrett's esophagus and dysplasia and early adenocarcinoma, The accuracy of ex vivo a nd in vivo methylene blue staining for specialized columnar epithelium was 87% and 90%, respectively. It was influenced by the length of Barrett's eso phagus, biopsy location, and the presence of esophagitis and/or dysplasia. Light to absent staining (p = 0.01) and moderate to marked heterogeneity (p = 0.01) were significantly associated with high grade dysplasia or cancer in the univariate analysis and in a multivariate model that adjusted for th e length of Barrett's esophagus acid the presence of a lesion. These staini ng characteristics were present in all patients with severe dysplasia and/o r adenocarcinoma, Conclusions: Highly dysplastic or malignant Barrett's esophagus stains diff erently with methylene blue. Increased heterogeneity and decreased methylen e blue stain intensity are significant independent predictors of high grade dysplasia and/or cancer. These features may help to direct biopsies in pat ients without a lesion.