WATS improves detection of high-grade dysplasia, cancer in Barrett’s

SAN DIEGO — The addition of wide area transepithelial sampling to the standard Seattle four-quadrant biopsy protocol resulted in a fourfold increase in the detection of high-grade dysplasia and esophageal adenocarcinoma among patients with Barrett’s esophagus, according to final results presented at DDW 2016.

Wide area transepithelial sampling (WATS, CDx Diagnostics) collects “a wide-area disaggregated tissue sample of the entire thickness of the suspect epithelium” using an abrasive brush biopsy tool, and the specimen is then analyzed by computer-assisted, three-dimensional image analysis, according to a press release.

Prashanth Vennalaganti

“We have actually shown high interobserver agreement among pathologists in the diagnosis of low grade dysplasia, high grade dysplasia or nondysplastic Barrett’s using WATS,” Prashanth Vennalaganti, MD, from the division of gastroenterology and hepatology at the Kansas City VA Medical Center, said during his presentation. “Our primary aim in this study was therefore to determine if the addition of WATS to standard four-quadrant biopsies every 1 to 2 centimeters will increase the detection rate of high grade dysplasia or cancer.”

Vennalaganti and colleagues performed a prospective, randomized controlled trial in which 160 BE patients (mean age, 63.4 years; 76% men; 95% white) from 16 centers underwent either standard forceps biopsies followed by WATS sampling (n = 81) or vice versa. Samples were then assessed by two Cleveland Clinic pathologists who were unaware of the biopsy method and each other’s findings.

Standard biopsies resulted in a diagnostic yield of 4.4% for high grade dysplasia or cancer, 17.5% for low-grade dysplasia or indefinite for dysplasia, 66.25% for non-dysplastic BE and 11.9% for no BE.

The addition of WATS identified 23 additional cases of high grade dysplasia or cancer, corresponding to an absolute increase of 14.4% (95% CI; 7.5-21.2) and a relative increase of 428%. WATS missed one case of high grade dysplasia or cancer identified by standard biopsies.

The mean procedure time was 4.5 minutes for WATS and 6.8 minutes for standard biopsies, for a difference of 2.34 minutes.

“WATS in conjunction with four-quadrants biopsies increased detection of BE-associated dysplasia and cancer,” Vennalaganti concluded. “Initial WATS followed by standard biopsies or vice versa had no effect on yield of dysplasia detection, and average time for WATS was significantly lower compared to standard biopsies.” – by Adam Leitenberger

Reference:

Vennalaganti P, et al. Abstract #60. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Vennalaganti reports no relevant financial disclosures. Please see the DDW disclosure list for all other researchers’ relevant financial disclosures.