Evidence map›Paper›PMID 26926447›Full record

ArticleDiagnostic pathology2016

Increasing diagnostic accuracy to grade dysplasia in Barrett's esophagus using an immunohistochemical panel for CDX2, p120ctn, c-Myc and Jagged1.

Dipti M Karamchandani, Heather L Lehman, Sara E Ohanessian, Julie Massé, Patricia A Welsh, Robert D Odze, John R Goldblum, Arthur S Berg, Douglas B Stairs

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Diagnostic pathology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.3field-weighted citation impact, top 20% of its field
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

4 citing papers in PubMed, 13 citations in OpenAlex.

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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

9 authors at 4 institutions in 1 country.

Dipti M KaramchandaniDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. dkaramchandani@hmc.psu.edu.
Heather L LehmanDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. hlehman@hmc.psu.edu.
Sara E OhanessianDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. saraohanessian@gmail.com.
Julie MasséDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. julimasse@gmail.com.
Patricia A WelshDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. paw14@psu.edu.
Robert D OdzeDepartment of Pathology, Brigham and Women's Hospital, Boston, MA, USA. rodze@partners.org.
John R GoldblumDepartment of Pathology, Cleveland Clinic, Cleveland, OH, USA. goldblj@ccf.org.
Arthur S BergDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA. aberg1@hmc.psu.edu.
Douglas B StairsDepartment of Pathology, The Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. dbs18@psu.edu.
Penn State Milton S. Hershey Medical Center · USBrigham and Women's Hospital · USCleveland Clinic · USPennsylvania State University · US

Funding

NCI NIH HHS L30 CA153290
6 · The paper itself

Abstract

backgroundPatients with non-dysplastic Barrett's esophagus (ND-BE) and low-grade dysplasia (LGD) are typically monitored by periodic endoscopic surveillance, while those with high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) are usually treated by more aggressive interventions like endoscopic mucosal resection, ablation or surgery. Therefore, the accurate grading of dysplasia in Barrett's esophagus (BE) is essential for proper patient care. However, there is significant interobserver and intraobserver variability in the histologic grading of BE dysplasia. The objective of this study was to create an immunohistochemical (IHC) panel that facilitates the grading of BE dysplasia and can be used as an adjunct to histology in challenging cases.

methods100 BE biopsies were re-graded for dysplasia independently by 3 subspecialized gastrointestinal pathologists. IHC staining for CDX2, p120ctn, c-Myc and Jagged1 proteins was then performed and assessed by two separate methods of semi-quantitative scoring. Scores were integrated using a principal component analysis (PCA) and receiver operating characteristic (ROC) curve.

resultsPrincipal component analysis demonstrated the ability of this panel of proteins to segregate ND-BE/LGD and HGD/EAC, as the expression of the four proteins is significantly altered between the two subsets. Analysis of the receiver operating characteristic curve showed that this panel has the potential to aid in the grading of dysplasia in these two subcategories with both high sensitivity and specificity. While not able to discriminate between ND-BE and LGD, this panel of four proteins may be used as an adjunct to help discriminate subsets of ND-BE/LGD from HGD/EAC.

conclusionsWe propose that the maximum utility of this IHC panel of CDX2, p120ctn, c-Myc, and Jagged1 proteins would be to distinguish between LGD and HGD in histologically challenging cases, given the aggressive interventions still used for HGD in many institutions, and hence may aid in the optimal patient management. The results of this initial study are promising, though further validation is needed before this panel can be used clinically, including future randomized prospective studies with larger patient cohorts from diverse locations.

Indexed as

ImmunohistochemistryAdenocarcinomaAdultAgedAged, 80 and overArea Under CurveBarrett EsophagusBiomarkers, TumorBiopsyCalcium-Binding ProteinsCateninsCDX2 Transcription FactorConsensusDelta CateninDiagnosis, DifferentialEsophageal NeoplasmsBiomarkers, TumorCalcium-Binding ProteinsCateninsCDX2 protein, humanCDX2 Transcription FactorCTNND1 protein, humanDelta CateninHomeodomain ProteinsIntercellular Signaling Peptides and ProteinsJAG1 protein, humanJagged-1 ProteinMembrane ProteinsMYC protein, humanProto-Oncogene Proteins c-mycSerrate-Jagged Proteins

Identifiers

PMID26926447
PMCPMC4772649
OpenAlexW2288363208

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Registered trials

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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.