Biomarkers detected patients at risk for esophageal cancer

2012 Gastrointestinal Cancers Symposium

SAN FRANCISCO — Researchers identified biomarkers that could improve early detection of esophageal cancer in patients with Barrett’s esophagus, according to data presented at the 2012 ASCO Gastrointestinal Cancers Symposium.

Patients with Barrett’s esophagus are currently screened for the presence of dysplasia or early-stage cancers through endoscopy and biopsies every 3 years. In this study, researchers examined the use of an alternative spatial-domain low-coherence quantitative phase microscopy to detect telltale changes in nuclear structure. Using this approach, researchers theorized that the biomarkers derived from nondysplastic intestinal metaplasia would distinguish Barrett’s esophagus patients with esophageal adenocarcinoma/high-grade dysplasia from those without neoplasia.

“If subsequent testing proves successful, our approach could lead to simpler and more effective ways of monitoring for patients with Barrett’s esophagus,” researcher Randall Brand, MD, professor of medicine at the University of Pittsburgh, said in a press release. “Such a monitoring program would identify a subset of high-risk Barrett’s patients who need more intensive surveillance and who could also be candidates for therapy to destroy the precancerous tissue.”

Researchers performed a retrospective study of archived tissue from 60 patients with Barrett’s esophagus who underwent Seattle protocol biopsies: 33 patients with intestinal metaplasia only and 27 patients with high-grade dysplasia (n=21) or esophageal adenocarcinoma (n=6).

According to the study, researchers were able to identify three optical biomarkers (nuclear optical path length, intra-nuclear uniformity, entropy) that can distinguish patients with nondysplastic Barrett’s esophagus from patients with esophageal adenocarcinoma and high-grade dysplasia with statistical significance (P<01). In addition, a prediction model combining all three optical biomarkers was able to differentiate Barrett’s esophagus patients with esophageal adenocarcinoma/high-grade dysplasia from patients with intestinal metaplasia only, with 89% sensitivity and 76% specificity.

“Our ultimate goal is to identify all patients with high-grade dysplasia and early cancers to allow early treatment, when therapy is most effective and the least invasive,” Brand said. “The problem is that sometimes intestinal metaplasia from a patient with high-grade dysplasia looks normal under a traditional microscope.”

According to researchers, the new technique could provide a more sensitive and accurate approach to monitoring for Barrett’s esophagus, requiring only two or three random biopsies, and may also allow the identification of a subset of patients with Barrett’s esophagus who require less frequent monitoring.

“The ability to have an additional test to help identify additional patients who may harbor a malignancy or precancerous condition like high-grade dysplasia in the background of Barrett's esophagus is indeed noteworthy and has a real chance of modifying how this patient population is followed and treated,” said Morton S. Kahlenberg, MD, a member of the 2012 Gastrointestinal Cancers Symposium News Planning Team.

For more information:

Brand R. Abstract #14. Presented at: ASCO Gastrointestinal Cancers Symposium; Jan. 19-21, 2012; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.

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