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Adding WATS3D to forceps biopsies improves detection of Barrett's esophagus, dysplasia
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HONOLULU — Wide area transepithelial sampling with computer-assisted three-dimensional analysis, or WATS3D, was shown to increase detection of Barrett’s esophagus and dysplasia when used as an adjunct to standard forceps biopsies, according to interim data from a prospective study presented at ACG 2015.
“Conventional sampling techniques using forceps biopsies leave a large area on the mucosal surface unsampled, which can lead to a risk of missing focal abnormalities such as dysplasia or neoplasia,” Erkanda P. Ikonomi, MD, from Temple University Hospital in Philadelphia, said during her presentation. “One possible solution to the sampling error is … WATS3D. Unlike standard soft cytology brushes, WATS uses an abrasive brush which can sample the circumference of the tubular esophagus as well as deeper layers of the epithelium as far as the lamina propria. This also obtains tissue fragments with cell aggregates, as well as individual cells, known as micro-biopsies.”
Erkanda P. Ikonomi
Aiming to confirm the adjunctive benefit of using WATS3D (CDx Diagnostics) with forceps biopsies for the detection of metaplasia, dysplasia or neoplasia in the community setting, Ikonomi and colleagues evaluated nearly 13,000 patients (39% male; mean age, 56 years) from 49 community GI practices, who underwent upper endoscopy for screening or surveillance for BE in which both forceps and WATS3D biopsies were performed. Forceps biopsy samples were analyzed by each site’s regular pathologist, while WATS3D samples were analyzed at a central laboratory by expert pathologists who were masked to the forceps biopsy results.
“The order in which the two biopsy techniques were used alternated monthly in order to eliminate sampling order bias,” Ikonomi said.
The most common indications for endoscopy were GERD, abdominal pain and BE, while the most common endoscopic findings were esophagitis, visible Barrett’s or irregular Z-line.
BE was detected in 1,772 (13.7%) of cases with forceps biopsy alone, and WATS3D detected an additional 2,668 cases of BE that were missed with forceps biopsy.
“Thus, the absolute incremental yield of adding WATS to forceps biopsy is 20.7%, increasing the rate of detection from 13.7% to 34.4% when the two techniques are used adjunctively,” Ikonomi said. “The augmented yield is 150.6%, and in other words, in order to detect an additional case of Barrett’s, five patients need to be tested with WATS3D in addition to forceps biopsies.”
Forceps biopsy detected 88 (0.68%) cases of dysplasia or neoplasia, and WATS3D detected an additional 213 cases of dysplasia that were missed by forceps biopsy (203 indeterminate or low-grade cases; 10 high-grade or adenocarcinoma).
“Thus, an additional 1.65% of cases of dysplasia were found when WATS was added to forceps biopsies, increasing the detection rate from 0.68% to 2.33%,” Ikonomi said. The relative increase in yield was 242%, and the number needed to test for an additional case of dysplasia by adding WATS3D to forceps biopsy is 61 patients, she added.
“In conclusion, this study, which is the largest WATS cohort to date, confirms the adjunctive benefit of this technique for detection of Barrett’s esophagus and associated dysplasia,” Ikonomi concluded. “Adjunctive yields were 150.6% for Barrett’s and 242% for dysplasia or neoplasia, which are even greater than what was found in prior studies with smaller sample sizes.” – by Adam Leitenberger
Reference:
Ikonomi EP, et al. Abstract 55. Presented at: ACG 2015; Oct. 19-21, 2015; Honolulu, HI.
Disclosures: Ikonomi reports no relevant financial disclosures. Please see the abstract for a full list of all other researchers’ relevant financial disclosures.