Evidence map›Paper›PMID 26416188›Full record

ArticleThe American journal of gastroenterology2015

Autofluorescence-Directed Confocal Endomicroscopy in Combination With a Three-Biomarker Panel Can Inform Management Decisions in Barrett's Esophagus.

Massimiliano di Pietro, Elizabeth L Bird-Lieberman, Xinxue Liu, Tara Nuckcheddy-Grant, Helga Bertani, Maria O'Donovan, Rebecca C Fitzgerald

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in The American journal of gastroenterology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  8. Article
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  14. Quantitation of spatial and temporal variability of biomarkers for Barrett's Esophagus.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2017
    Article
  15. Past, present and future of Barrett's oesophagus.European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2017
    Review
  16. Recent Advances in Non-invasive Esophageal Tissue Sampling.Current gastroenterology reports · 2017
    Review
  17. Article
  18. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Massimiliano di PietroMRC Cancer Unit, University of Cambridge, Cambridge, UK.
Elizabeth L Bird-LiebermanMRC Cancer Unit, University of Cambridge, Cambridge, UK.
Xinxue LiuMRC Cancer Unit, University of Cambridge, Cambridge, UK.
Tara Nuckcheddy-GrantMRC Cancer Unit, University of Cambridge, Cambridge, UK.
Helga BertaniDepartment of Digestive Endoscopy, Nuovo Ospedale Civile S. Agostino, Modena, Italy.
Maria O'DonovanDepartment of Histopathology, Cambridge University Hospitals, Cambridge, UK.
Rebecca C FitzgeraldMRC Cancer Unit, University of Cambridge, Cambridge, UK.

Funding

Department of Health NIHR-RP-02-12-011Medical Research Council MC_UU_12022/2
6 · The paper itself

Abstract

objectivesBarrett's esophagus (BE) surveillance with white-light endoscopy and quadrantic biopsies (Seattle protocol) is resource intensive and limited by sampling error. Previous work suggests that autofluorescence imaging (AFI) in combination with a molecular panel might reduce the number of biopsies, but this was not sufficiently sensitive for low-grade dysplasia, now a point for endoscopic intervention. Here we used AFI to direct narrow-field imaging tools for real-time optical assessment of dysplasia and biopsies for a biomarker panel. We compared the new diagnostic algorithm with the current standard.

methodsA total of 55 patients with BE were recruited at a single tertiary referral center. Patients underwent high-resolution endoscopy followed by AFI. AFI-targeted areas (n=194) were examined in turn by narrow-band imaging with magnification (NBIz) and probe-based confocal laser endomicroscopy (pCLE). Biopsies were taken from AFI-targeted areas and tested using an established molecular panel comprising aneuploidy plus cyclin A and p53 immunohistochemistry.

resultsIn the per-patient analysis the overall sensitivity and specificity of AFI-targeted pCLE were 100% and 53.6% for high-grade dysplasia/intramucosal cancer and 96.4% and 74.1% for any grade of dysplasia, respectively. NBIz had equal specificity for dysplasia detection (74.1%), but significantly lower sensitivity (57.1%) than pCLE. The time required to perform AFI-targeted pCLE was shorter that that taken by the Seattle protocol (P=0.0004). We found enrichment of molecular abnormalities in areas with optical dysplasia by pCLE (P<0.001), regardless of histologic dysplasia. The addition of the 3-biomarker panel reduced the false positive rate of pCLE by 50%, leading to sensitivity and specificity for any grade of dysplasia of 89.2% and 88.9%, respectively.

conclusionsThe combination of pCLE on AFI-targeted areas and a 3-biomarker panel identifies patients with dysplasia.

Indexed as

Optical ImagingAgedAlgorithmsAneuploidyBarrett EsophagusBiomarkersBiopsyCyclin ADisease ProgressionEsophagoscopyEsophagusFalse Positive ReactionsFemaleHumansMaleMicroscopy, ConfocalBiomarkersCyclin ATumor Suppressor Protein p53

Identifiers

PMID26416188

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.