Identifying Intestinal Metaplasia at the Squamocolumnar Junction by Using Optical Coherence Tomography
Evans, John A.
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CitationEvans, John A., Brett E. Bouma, Jason Bressner, Milen Shishkov, Gregory Y. Lauwers, Mari Mino-Kenudson, Norman S. Nishioka, and Guillermo J. Tearney. 2007. Identifying intestinal metaplasia at the squamocolumnar junction by using optical coherence tomography. Gastrointestinal Endoscopy 65(1): 50–56.
AbstractBackground: Optical coherence tomography (OCT) is an optical imaging method that produces high-resolution cross-sectional images of the esophagus. The accuracy of OCT for differentiating tissue types at the squamocolumnar junction (SCJ) has not been established. Objective: The purpose of this study was to identify and validate OCT image criteria for distinguishing metaplastic from nonmetaplastic tissue at the SCJ. Design: A total of 196 biopsy-correlated OCT images of the SCJ were acquired from 113 patients undergoing upper endoscopy. A pathologist blinded to the OCT results reviewed each pathology specimen and determined the presence of the following histopathology: gastric cardia, squamous mucosa, pancreatic metaplasia, and intestinal metaplasia. An algorithm for diagnosing specialized intestinal metaplasia (SIM) was created by reviewing a training set of 40 biopsy-correlated OCT images. Two blinded investigators prospectively tested the algorithm on a validation set of 123 images. Results: OCT images of squamous mucosa were characterized by a layered appearance without epithelial glands; gastric cardia, by vertical pit and gland structure, a well-defined epithelial surface reflectivity, and relatively poor image penetration; and SIM by an irregular architecture and good image penetration. The OCT criteria were 85% sensitive and 95% specific for SIM when applied retrospectively to the training set. When applied to the validation set, the algorithm was 81% sensitive for both OCT readers and 66% and 57% specific for diagnosing SIM. The interobserver agreement was good (κ = 0.53). Conclusions: OCT imaging can identify SIM at the SCJ with an accuracy similar to that of endoscopy.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12601540
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