This article is more than 5 years old. Information may no longer be current.
Four to six biopsy fragments optimized EoE diagnoses
At least four biopsy fragments from the mid and/or proximal esophagus — but no more than six — were required to optimize the chances of diagnosing eosinophilic esophagitis, according to new study results.
Investigators reviewed 102 sequential eosinophilic esophagitis (EoE) cases (all with biopsies from the mid and distal esophagus) from January 2009 to September 2011. Data on the number of biopsy fragments containing squamous mucosa were recorded from a review of hematoxylin and eosin (H&E)-stained slides. The number of eosinophils per high power field (EOS/HPF) in up to three HPFs was counted in each fragment using a x40 objective and x10 oculars (field diameter, 0.52 mm; field area, 0.21 mm2).
There were 1,342 biopsy fragments analyzed for EOS/HPF. The mid esophagus yielded one to 20 (mean 7; median 7), and the distal esophagus produced one to 18 (mean 6; median 5).
The mean EOS/HPF was similar for the mid (26) and lower (25) esophagus when compared with the mean peak EOS/HPF for the mid (69.1) and lower (60.4) esophagus.
“In order to morphologically exclude a diagnosis of reflux esophagitis as the cause of intraepithelial eosinophilia, distal esophageal biopsies, if obtained, must be accompanied by more proximal biopsies,” the researchers wrote.
Researchers reported the following calculated sensitivities for biopsy fragments containing at least 15 EOS/HPF as:
- one fragment, 62.6%
- three fragments, 94.8%
- four fragments, 98.1%
- five fragments, 99.3%
“Our data and that of other studies demonstrate that although there is an increased number of eosinophils in the distal esophagus of patients with EoE compared with other regions of the esophagus, the difference is not statistically significant,” the investigators wrote.
Disclosure:The study was funded by ProPath Service.