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Combined EsophaCap cytology and MUC2 immunohistochemistry for screening of intestinal metaplasia, dysplasia and carcinoma

Authors Zhou Z, Kalatskaya I, Russell D, Marcon N, Cirocco M, Krzyzanowski PM, Streutker C, Liang H, Litle VR, Godfrey TE, Stein L

Received 9 September 2018

Accepted for publication 30 March 2019

Published 15 May 2019 Volume 2019:12 Pages 219—229

DOI https://doi.org/10.2147/CEG.S186958

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Wing-Kin Syn


Zhongren Zhou,1 Irina Kalatskaya,2 Donna Russell,1 Norman Marcon,3 Maria Cirocco,3 Paul M Krzyzanowski,2 Cathy Streutker,3 Hua Liang,4 Virginia R Litle,5 Tony E Godfrey,5 Lincoln Stein2

1Department of Pathology & Immunology, Washington University, Saint Louis, MO, USA; 2Department of Adaptive Oncology, Ontario Institute for Cancer Research, Toronto, Ontario, Canada; 3Division of Gastroenterology, Department of Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada; 4Department of Statistics, George Washington University, Washington, DC, USA; 5Department of Surgery, Boston University School of Medicine, Boston, MA, USA

Purpose: The incidence of esophageal adenocarcinoma (EAC) has increased by 700% in Western countries over the last 30 years. Although clinical guidelines call for endoscopic surveillance for EAC among high-risk populations, fewer than 5% of new EAC patients are under surveillance at the time of diagnosis. We studied the accuracy of combined cytopathology and MUC2 immunohistochemistry (IHC) for screening of Intestinal Metaplasia (IM), dysplasia and EAC, using specimens collected from the EsophaCap swallowable encapsulated cytology sponge from Canada and United States.
Patients and methods: By comparing the EsophaCap cytological diagnosis with concurrent endoscopic biopsies performed on the same patients in 28 cases, we first built up the cytology diagnostic categories and criteria. Based on these criteria, 136 cases were evaluated by both cytology and MUC2 IHC with blinded to patient biopsy diagnosis.
Results: We first set up categories and criteria for cytological diagnosis of EscophaCap samples. Based on these, we divided our evaluated cytological samples into two groups: non-IM group and IM or dysplasia or adenocarcinoma group. Using the biopsy as our gold standard to screen IM, dysplasia and EAC by combined cytology and MUC2 IHC, the sensitivity and specificity were 68% and 91%, respectively, which is in the range of clinically useful cytological screening tests such as the cervical Pap smear.
Conclusions: Combined EsophaCap cytology and MUC2 IHC could be a good screening test for IM and Beyond.

Keywords: Barrett’s esophagus, esophageal adenocarcinoma, cytology screening, MUC2 IHC, EsophaCap, intestinal metaplasia

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