Prevalence and Predictors of Missed Dysplasia on Index Barrett’s Esophagus Diagnosing Endoscopy in a Veteran Population

Wenker, Theresa Nguyen; Thrift, Aaron P.; George, Rollin; Rosen, Daniel; El–Serag, Hashem B.; Ketwaroo, Gyanprakash A.

doi:10.1016/j.cgh.2021.04.008

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Post-endoscopy incident oesophageal cancer is estimated to account for 14% of the oesophageal cancer burden 21 and missed dysplasia at index endoscopy accounts for around 10% of cancer cases. 22 , 23 In a randomised crossover trial with two endoscopies performed 6 weeks apart (in 153 patients) to assess the utility of confocal endomicroscopy, inconspicuous dysplasia was missed by the standard white-light Seattle protocol in approximately 50% of cases. 24 Low-grade dysplasia is, however, prone to overdiagnosis unless diagnosed by consensus.…”

Section: Discussionmentioning

confidence: 99%

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot

Pilonis¹,

Killcoyne²,

Tan³

et al. 2022

The Lancet Oncology

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Background Endoscopic surveillance is recommended for patients with Barrett's oesophagus because, although the progression risk is low, endoscopic intervention is highly effective for high-grade dysplasia and cancer. However, repeated endoscopy has associated harms and access has been limited during the COVID-19 pandemic. We aimed to evaluate the role of a non-endoscopic device (Cytosponge) coupled with laboratory biomarkers and clinical factors to prioritise endoscopy for Barrett's oesophagus. MethodsWe first conducted a retrospective, multicentre, cross-sectional study in patients older than 18 years who were having endoscopic surveillance for Barrett's oesophagus (with intestinal metaplasia confirmed by TFF3 and a minimum Barrett's segment length of 1 cm [circumferential or tongues by the Prague C and M criteria]). All patients had received the Cytosponge and confirmatory endoscopy during the BEST2 (ISRCTN12730505) and BEST3 (ISRCTN68382401) clinical trials, from July 7, 2011, to April 1, 2019 (UK Clinical Research Network Study Portfolio 9461). Participants were divided into training (n=557) and validation (n=334) cohorts to identify optimal risk groups. The biomarkers evaluated were overexpression of p53, cellular atypia, and 17 clinical demographic variables. Endoscopic biopsy diagnosis of high-grade dysplasia or cancer was the primary endpoint. Clinical feasibility of a decision tree for Cytosponge triage was evaluated in a real-world prospective cohort from Aug 27, 2020 (DELTA; ISRCTN91655550; n=223), in response to COVID-19 and the need to provide an alternative to endoscopic surveillance. Findings The prevalence of high-grade dysplasia or cancer determined by the current gold standard of endoscopic biopsy was 17% (92 of 557 patients) in the training cohort and 10% (35 of 344) in the validation cohort. From the new biomarker analysis, three risk groups were identified: high risk, defined as atypia or p53 overexpression or both on Cytosponge; moderate risk, defined by the presence of a clinical risk factor (age, sex, and segment length); and low risk, defined as Cytosponge-negative and no clinical risk factors. The risk of high-grade dysplasia or intramucosal cancer in the high-risk group was 52% (68 of 132 patients) in the training cohort and 41% (31 of 75) in the validation cohort, compared with 2% (five of 210) and 1% (two of 185) in the low-risk group, respectively. In the real-world setting, Cytosponge results prospectively identified 39 (17%) of 223 patients as high risk (atypia or p53 overexpression, or both) requiring endoscopy, among whom the positive predictive value was 31% (12 of 39 patients) for high-grade dysplasia or intramucosal cancer and 44% (17 of 39) for any grade of dysplasia. Interpretation Cytosponge atypia, p53 overexpression, and clinical risk factors (age, sex, and segment length) could be used to prioritise patients for endoscopy. Further investigation could validate their use in clinical practice and lead to a substantial reduction in endoscopy procedures compared with current ...

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Section: Discussionmentioning

confidence: 99%

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot

Pilonis¹,

Killcoyne²,

Tan³

et al. 2022

The Lancet Oncology

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“…We aimed to determine the effect of endoscopy duration on dysplasia detection. Both endoscopist experience [18,19] and BE length [20] have been shown to influence dysplasia detection. These factors may also impact endoscopy duration.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2023

Endoscopy

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“…The percentage of squamous epithelium that fails to mature at the epithelium’s interface is termed low-grade dysplasia (LGD)/CIN I, high-grade dysplasia (HGD)/CIN II, as well as CIN III and additional CIS ( 7 ). Early detection and diagnosis of this cancer form are crucial for effective treatment.…”

Section: Introductionmentioning

confidence: 99%

HO-SsNF: heap optimizer-based self-systematized neural fuzzy approach for cervical cancer classification using pap smear images

Shanmugam,

KVN,

Radhabai

et al. 2024

Front. Oncol.

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Cervical cancer is a significant concern for women, necessitating early detection and precise treatment. Conventional cytological methods often fall short in early diagnosis. The proposed innovative Heap Optimizer-based Self-Systematized Neural Fuzzy (HO-SsNF) method offers a viable solution. It utilizes HO-based segmentation, extracting features via Gray-Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP). The proposed SsNF-based classifier achieves an impressive 99.6% accuracy in classifying cervical cancer cells, using the Herlev Pap Smear database. Comparative analyses underscore its superiority, establishing it as a valuable tool for precise cervical cancer detection. This algorithm has been seamlessly integrated into cervical cancer diagnosis centers, accessible through smartphone applications, with minimal resource demands. The resulting insights provide a foundation for advancing cancer prevention methods.

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Prevalence and Predictors of Missed Dysplasia on Index Barrett’s Esophagus Diagnosing Endoscopy in a Veteran Population

Cited by 6 publications

References 31 publications

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot

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HO-SsNF: heap optimizer-based self-systematized neural fuzzy approach for cervical cancer classification using pap smear images

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