Combined EsophaCap cytology and MUC2 immunohistochemistry for screening of intestinal metaplasia, dysplasia and carcinoma

Abstract

Purpose: The incidence of esophageal adenocarcinoma (EAC) has increased by 700% in Western countries over the last 30 years. Although clinical guidelines call for endoscopic surveillance for EAC among high-risk populations, fewer than 5% of new EAC patients are under surveillance at the time of diagnosis. We studied the accuracy of combined cytopathology and MUC2 immunohistochemistry (IHC) for screening of Intestinal Metaplasia (IM), dysplasia and EAC, using specimens collected from the EsophaCap swallowable encapsulated cytology sponge from Canada and United States.

Patients and methods: By comparing the EsophaCap cytological diagnosis with concurrent endoscopic biopsies performed on the same patients in 28 cases, we first built up the cytology diagnostic categories and criteria. Based on these criteria, 136 cases were evaluated by both cytology and MUC2 IHC with blinded to patient biopsy diagnosis.

Results: We first set up categories and criteria for cytological diagnosis of EscophaCap samples. Based on these, we divided our evaluated cytological samples into two groups: non-IM group and IM or dysplasia or adenocarcinoma group. Using the biopsy as our gold standard to screen IM, dysplasia and EAC by combined cytology and MUC2 IHC, the sensitivity and specificity were 68% and 91%, respectively, which is in the range of clinically useful cytological screening tests such as the cervical Pap smear.

Conclusions: Combined EsophaCap cytology and MUC2 IHC could be a good screening test for IM and Beyond.

Keywords:

• Barrett’s esophagus
• esophageal adenocarcinoma
• cytology screening
• MUC2 IHC
• EsophaCap
• intestinal metaplasia

Acknowledgments

We want to thank all support from cytology technician, immunohistochemistry (Qi Yang and Loralee McMahon) and histology staffs at University of Rochester.

Abbreviation list

AGC, atypical glandular cells; CCNGC, columnar cell with no goblet cell; CM, columnar metaplasia; EAC, esophageal adenocarcinoma; HGD, high-grade dysplasia; ID, indefinite dysplasia; IHC, immunohistochemistry; IM, intestinal metaplasia; IMNHGD, intestinal metaplasia with no high-grade dysplasia; LGD, low-grade dysplasia; NCC, no or rare columnar cell; ND, non-diagnostic; SFEAC, suspicious for esophageal adenocarcinoma.

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.