Nuclear Nano-architecture Markers of Gastric Cardia and Upper Squamous Esophagus Detect Esophageal Cancer "Field Effect".
Nuclear Nano-architecture Markers of Gastric Cardia and Upper Squamous Esophagus Detect Esophageal Cancer "Field Effect".
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DOI：
10.7150/jca.6990
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发表时间：
2013
影响因子：
3.9
通讯作者：
Liu Y
中科院分区：
文献类型：
--
作者：
Fasanella KE;Bista RK;Staton K;Rizvi S;Uttam S;Zhao C;Sepulveda A;Brand RE;McGrath K;Liu Y
背景资料：巴雷特食管（BE）影响多达1200万美国人，并增加了食管腺癌（EAC）的发展风险。EAC通常是致命的，除非及早发现。鉴于高患病率，高成本的监测和相对较低的风险，大多数受影响的个人，识别高风险的患者进行额外的审查，定期监测，或消融治疗是至关重要的。通过探测未受累食管粘膜来预测EAC风险的“场效应”探索有可能作为一种改进的监测和预防策略。在这项研究中，我们评估的能力，核纳米结构标志物从正常鳞状食管和贲门检测食管异型增生和EAC的“场效应”，以及他们对内镜治疗的反应。方法：正常食管、胃食管反流、BE和EAC患者入组。我们对胃食管交界处以下约1-2 cm处的胃贲门和距门齿约20 cm处的正常鳞状食管粘膜进行了内镜细胞学刷检，并使用Thinprep方法制作了标准细胞学切片。对细胞学正常外观的上皮细胞的细胞核进行光学分析。结果：研究队列包括128例患者。核纳米结构标志物检测食管异型增生和EAC的存在具有统计学意义。场效应不表现出空间依赖性。这些标志物在内镜治疗后恢复正常。结论：胃贲门和上鳞状食管的光学分析代表了一种潜在可行的方法，以改善风险分层和易于监测的巴瑞特食管患者，并监测消融治疗的疗效。
Background: Barrett's esophagus (BE) affects up to 12 million Americans and confers an increased risk for development of esophageal adenocarcinoma (EAC). EAC is often fatal unless detected early. Given the high prevalence, high cost of surveillance and relatively low risk of most affected individuals, identification of high-risk patients for additional scrutiny, regular surveillance, or ablative therapy is crucial. The exploration of “field effect” by probing uninvolved esophageal mucosa to predict the risk of EAC has the potential as an improved surveillance and prevention strategy. In this study, we evaluate the ability of nuclear nano-architecture markers from normal squamous esophagus and gastric cardia to detect the “field effect” of esophageal dysplasia and EAC, and their response to endoscopic therapy. Methods: Patients with normal esophagus, gastroesophageal reflux, BE and EAC were eligible for enrollment. We performed endoscopic cytology brushings of the gastric cardia, ~1-2 cm below the gastroesophageal junction, and of the normal squamous esophageal mucosa at ~20 cm from the incisors and standard cytology slides were made using Thinprep method. Optical analysis was performed on the cell nuclei of cytologically normal-appearing epithelial cells. Results: The study cohort consisted of 128 patients. The nuclear nano-architecture markers detected the presence of esophageal dysplasia and EAC with statistical significance. The field effect does not exhibit a spatial dependence. These markers reverted toward normal in response to endoscopic therapy. Conclusions: Optical analysis of gastric cardia and upper squamous esophagus represents a potentially viable method to improve risk stratification and ease of surveillance of patients with Barrett's esophagus and to monitor the efficacy of ablative therapy.
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