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Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus.
Dig Liver Dis. 2006 Oct; 38(10):724-9.DL

Abstract

BACKGROUND

Barrett's oesophagus embodies the risk of malignant transformation. High-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus are often discrete or macroscopically occult lesions and show a patchy distribution and therefore, directed biopsies in combination with four-quadrant random biopsies are the gold standard for surveillance.

AIMS

The aim of this prospective study was to compare methylene blue staining and random biopsies in patients with early Barrett's neoplasia.

PATIENTS AND METHODS

Eighty-six patients (mean age 65+/-8 years) with histologically proven but macroscopically in evident high-grade intraepithelial neoplasia (n=17) or early cancer in Barrett's oesophagus (n=69) on HR-endoscopy with all together 98 lesions, were included. In the first step, four-quadrant random biopsies were taken during routine endoscopy (group I). In a second step, staining was performed with a 0.5% solution of methylene blue with a spray catheter. Biopsies of focal areas with decreased stain, heterogeneity of stain or absence stain were taken (group II).

RESULTS

In 75/86 patients, high-grade intraepithelial neoplasia or early cancer in Barrett's oesophagus could be diagnosed in the methylene blue group while 56 patients were determined in the random biopsies group (P=0.053). High-grade intraepithelial neoplasia or early cancer was diagnosed in significantly more methylene blue-directed biopsies (80.9% versus 26.4%, P<0.005) and also significantly more lesions could be identified in the methylene blue group (96/98; 98%) while in the random biopsies group only 58/98 lesions (59%) could be localised (P<0.05). When methylene blue was used (1217 versus 562, P<0.0001), the average number of specimens taken with methylene blue per patient was about half of that with random biopsy (6.5 versus 14.1, P<0.0001).

CONCLUSIONS

Chromoendoscopy with methylene blue diagnosed significantly more patients and lesions with intraepithelial neoplasia or early cancer in Barrett's oesophagus compared to random biopsies. In addition, significantly less biopsies were needed with methylene blue compared to random biopsies. The use of methylene blue-directed biopsies appears to improve the detection of intraepithelial neoplasia and early cancer in Barrett's oesophagus.

Authors+Show Affiliations

Department of Medicine II, Dr. Horst Schmidt Hospitals (HSK), Wiesbaden (Medical School of the University of Mainz), Germany. liebwin.gossner@arcor.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16911879

Citation

Gossner, L, et al. "Comparison of Methylene Blue-directed Biopsies and Four-quadrant Biopsies in the Detection of High-grade Intraepithelial Neoplasia and Early Cancer in Barrett's Oesophagus." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 38, no. 10, 2006, pp. 724-9.
Gossner L, Pech O, May A, et al. Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus. Dig Liver Dis. 2006;38(10):724-9.
Gossner, L., Pech, O., May, A., Vieth, M., Stolte, M., & Ell, C. (2006). Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 38(10), 724-9.
Gossner L, et al. Comparison of Methylene Blue-directed Biopsies and Four-quadrant Biopsies in the Detection of High-grade Intraepithelial Neoplasia and Early Cancer in Barrett's Oesophagus. Dig Liver Dis. 2006;38(10):724-9. PubMed PMID: 16911879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus. AU - Gossner,L, AU - Pech,O, AU - May,A, AU - Vieth,M, AU - Stolte,M, AU - Ell,C, Y1 - 2006/09/05/ PY - 2006/03/29/received PY - 2006/05/29/revised PY - 2006/05/31/accepted PY - 2006/8/17/pubmed PY - 2007/2/3/medline PY - 2006/8/17/entrez SP - 724 EP - 9 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 38 IS - 10 N2 - BACKGROUND: Barrett's oesophagus embodies the risk of malignant transformation. High-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus are often discrete or macroscopically occult lesions and show a patchy distribution and therefore, directed biopsies in combination with four-quadrant random biopsies are the gold standard for surveillance. AIMS: The aim of this prospective study was to compare methylene blue staining and random biopsies in patients with early Barrett's neoplasia. PATIENTS AND METHODS: Eighty-six patients (mean age 65+/-8 years) with histologically proven but macroscopically in evident high-grade intraepithelial neoplasia (n=17) or early cancer in Barrett's oesophagus (n=69) on HR-endoscopy with all together 98 lesions, were included. In the first step, four-quadrant random biopsies were taken during routine endoscopy (group I). In a second step, staining was performed with a 0.5% solution of methylene blue with a spray catheter. Biopsies of focal areas with decreased stain, heterogeneity of stain or absence stain were taken (group II). RESULTS: In 75/86 patients, high-grade intraepithelial neoplasia or early cancer in Barrett's oesophagus could be diagnosed in the methylene blue group while 56 patients were determined in the random biopsies group (P=0.053). High-grade intraepithelial neoplasia or early cancer was diagnosed in significantly more methylene blue-directed biopsies (80.9% versus 26.4%, P<0.005) and also significantly more lesions could be identified in the methylene blue group (96/98; 98%) while in the random biopsies group only 58/98 lesions (59%) could be localised (P<0.05). When methylene blue was used (1217 versus 562, P<0.0001), the average number of specimens taken with methylene blue per patient was about half of that with random biopsy (6.5 versus 14.1, P<0.0001). CONCLUSIONS: Chromoendoscopy with methylene blue diagnosed significantly more patients and lesions with intraepithelial neoplasia or early cancer in Barrett's oesophagus compared to random biopsies. In addition, significantly less biopsies were needed with methylene blue compared to random biopsies. The use of methylene blue-directed biopsies appears to improve the detection of intraepithelial neoplasia and early cancer in Barrett's oesophagus. SN - 1590-8658 UR - https://www.unboundmedicine.com/medline/citation/16911879/Comparison_of_methylene_blue_directed_biopsies_and_four_quadrant_biopsies_in_the_detection_of_high_grade_intraepithelial_neoplasia_and_early_cancer_in_Barrett's_oesophagus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(06)00238-6 DB - PRIME DP - Unbound Medicine ER -