The Seattle Protocol Does Not More Reliably Predict the Detection of Cancer at the Time of Esophagectomy Than a Less Intensive Surveillance Protocol

Kariv, Revital; Plesec, Thomas; Goldblum, John R.; Bronner, Mary P.; Oldenburgh, Mary; Rice, Thomas W.; Falk, Gary W.

doi:10.1016/j.cgh.2008.11.024

Cited by 91 publications

(56 citation statements)

References 52 publications

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“…A recent paper has indicated that even small clones could develop into cancers (16) . Furthermore, this has been confi rmed by a study that indicates that even the Seattle quadrantic biopsy protocol may not be suffi cient to detect all cancers (17) .…”

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confidence: 83%

Editorial: One Small Step for Metaplasia, but One Giant Leap for Biomarkers Is Needed

Nicholson¹,

Jankowski²

2009

Am J Gastroenterol

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There are 5 to 6 levels of biomarker validation. Those for Barrett's esophagus are currently at level 3, despite small prospective studies. What is ideally required is a very large prospective assessment of biopsies in large cohorts, such as the ASPirin Esomeprazole Chemoprevention Trial (AspECT) and Barrett's Oesophagus Surveillance Study (BOSS) trials, so that unbiased and random selection of cases can be subjected to rigorous pathology and biomarker assessment (level 4). Only then can the predictive power of the data be exploited in a randomized intervention trial (level 5) whereby a series of biomarkers would trigger therapy. The real trouble is that this spot is currently occupied, satisfactorily according to some researchers, by conventional histological identifi cation of high-grade dysplasia (HGD) as used in a recent randomized study of ablation in Barrett ' s esophagus (BE). Am J Gastroenterol 2009; 104:2681-2683 doi: 10.1038/ajg.2009 Esophageal adenocarcinoma is still increasing in incidence, and is currently the fi ft h most common of fatal cancers worldwide (1) . Yet with only 5 % of patients diagnosed with its main risk factor, Barrett's esophagus (BE), will go on to develop fatal adenocarcinoma (2) . Th ere is a need for a preventive strategy that can use biomarkers that will allow for more effi cient screening or surveillance programs. Biomarkers are clinical variables associated with clinical outcomes, and although there were early successes (3,4) as well as some more recent discoveries (5 -8) in identifying predictive biomarkers for BE, they are still not used in clinical practice ( Figure 1 ).

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confidence: 83%

Editorial: One Small Step for Metaplasia, but One Giant Leap for Biomarkers Is Needed

Nicholson¹,

Jankowski²

2009

Am J Gastroenterol

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“…Reid et al 47 intensified the classical protocol to four quadrant biopsies every 1 cm for patients followed up after a diagnosis of HGD and suggested that a 2 cm biopsy protocol would miss 50% of the cancers. In contrast, Kariv et al 51 found that a 2 cm interval for the biopsy protocol was sufficient to detect cancer prior to esophagectomy. Studies using advanced imaging techniques in experienced referral centers suggest that in the future there may be a role for new techniques to replace the Seattle protocol, but currently there are insufficient data to support this.…”

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confidence: 98%

Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative

et al. 2016

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“…The Seattle multiple biopsy protocol (4 quadrant jumbo biopsies every 1 cm with additional biopsies of mucosal abnormalities), is considered to be the optimal method for surveillance of Barrett's esophagus, although it has never been validated [27,30] . However, even the most intensive biopsy protocols are associated with significant sampling errors [31,32] . By convention, there are four broad categories used by pathologists to describe the dysplastic process in Barrett's: (1) no dysplasia; (2) indefinite for dysplasia; (3) low-grade dysplasia; and (4) high-grade dysplasia; which corresponds to groups 1 to 4 according to the revised Vienna [14] classification for gastrointestinal epithelial neoplasia.…”

Section: Discussionmentioning

confidence: 99%

Endocytoscopic visualization of squamous cell islands within Barrett’s epithelium

Eleftheriadis¹

2013

WJGE

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AIM:To study the endocytoscopic visualization of squamous cell islands within Barrett's epithelium. METHODS:Endocytoscopy (ECS) has been studied in the surveillance of Barrett's esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for the staining of Barrett's mucosa. Integrated type endocytoscopes (GIF-Q260 EC, Olympus Corp, Tokyo, Japan) have been recently developed, with the incorporation of a high-power magnifying endocytoscope into a standard endoscope together with narrow-band imaging (NBI). Moreover, double staining with a mixture of 0.05% crystal violet and 0.1% of methylene blue (CM) during ECS enables higher quality images comparable to conventional hematoxylin eosin histopathological images. RESULTS:In vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett's epithelium in a patient with long-segment Barrett's esophagus is reported. Conventional white light endoscopy showed typical long-segment Barrett's esophagus, with small squamous cell islands within normal Barrett's mucosa, which were better visualized by NBI endoscopy. ECS after double CM staining showed regular Barrett's esophagus, while higher magnification (× 480) revealed the orifices of glandular structures better. Furthermore, typical squamous cell papillary protrusion, classified as endocytoscopic atypia classification (ECA) 2 according to ECA, was identified within regular glandular Barrett's mucosa. Histological examination of biopsies taken from the same area showed squamous epithelium within glandular Barrett's mucosa, corresponding well to endocytoscopic findings. CONCLUSION:To our knowledge, this is the first report of in vivo visualization of esophageal papillary squamous cell islands surrounded by glandular Barrett's epithelium.© 2013 Baishideng. All rights reserved.Key words: Endocytoscopy; Barrett's esophagus; Surveillance; Endocytoscopic atypia classification; Crystal violet; Methylene blue; Hematoxylin eosin stain Core tip: Endocytoscopy has been also studied in surveillance of Barrett's esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for staining of Barrett's mucosa. In the present study, in vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett's epithelium in a patient with long-segment Barrett's esophagus is reported.

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The Seattle Protocol Does Not More Reliably Predict the Detection of Cancer at the Time of Esophagectomy Than a Less Intensive Surveillance Protocol

Cited by 91 publications

References 52 publications

Editorial: One Small Step for Metaplasia, but One Giant Leap for Biomarkers Is Needed

Editorial: One Small Step for Metaplasia, but One Giant Leap for Biomarkers Is Needed

Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative

Endocytoscopic visualization of squamous cell islands within Barrett’s epithelium

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