Nicholas J. Shaheen
PHILADELPHIA – A finding of crypt dysplasia using a computer-assisted sampling system known as WATS3D helped predict a more histologically aggressive form of Barrett’s esophagus, according to research presented at the American College of Gastroenterology Annual Meeting.
Shaheen, MD, MPH, FACG, of the University of North Carolina, and colleagues found that WATS (CDx Medical) predicted progression from non-dysplastic BE (NDBE) or low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma (EAC) at rates comparable to or better than the reported risk for progression in forceps biopsy.
“WATS3D sampling, an adjunct to forceps biopsy, uses brush cytology to evaluate routine histologic and cytologic features,” Shaheen said during his presentation. “BE with crypt dysplasia is diagnosed in instances where dysplasia-like atypia involved the crypts, but not the surface epithelium. The clinical relevance of this finding is uncertain. Often clinically this is called normal or indefinite for dysplasia.”
Investigators analyzed data from 4,512 patients who underwent WATS as part of routine care between 2013 and 2018. They included patients who had two WATS at least 6 months apart, categorized them based on their initial WATS findings (NDBE, LGD and crypt dysplasia) and determined progression rates on a per patient year basis.
Researchers followed 4,048 patients with NDBE for an average of 1.4 years between assays and experienced 19 progressions to high-grade dysplasia or EAC (0.33% per patient year). In 380 patients with crypt dysplasia, 10 experienced progression to HGD or EAC (2.1% per patient year), a rate Shaheen said was markedly higher than patients with NDBE. In 83 patients with WATS-detected LGD, eight progressed to HGD or EAC (7.7% per patient year).
When it found NDBE or LGD, Shaheen said WATS was able to predict progression to HGD or EAC at a rate comparable to or better than NDBE or LGD confirmed by forceps biopsy. WATS was also comparable to forceps in assessing progression risk for LGD.
“Crypt dysplasia is commonly missed by forceps biopsy, none of those 10 were caught on forceps biopsy,” he said. “Crypt dysplasia is important. It has a risk of progression markedly higher than [NDBE] and comparable to forceps biopsy-confirmed [LGD] in previous studies.” – by Alex Young
: Shaheen NJ, et al. Presidential Plenary Session 1: Abstract 3. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.
Disclosures: Shaheen reports financial ties to CDx Medical. Please see the study abstract for all other author’s relevant financial disclosures.