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Gastrointest Endosc. 2007 Jan;65(1):50-6. Epub 2006 Sep 20.

Identifying intestinal metaplasia at the squamocolumnar junction by using optical coherence tomography.

Author information

1
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Optical coherence tomography (OCT) is an optical imaging method that produces high-resolution cross-sectional images of the esophagus. The accuracy of OCT for differentiating tissue types at the squamocolumnar junction (SCJ) has not been established.

OBJECTIVE:

The purpose of this study was to identify and validate OCT image criteria for distinguishing metaplastic from nonmetaplastic tissue at the SCJ.

DESIGN:

A total of 196 biopsy-correlated OCT images of the SCJ were acquired from 113 patients undergoing upper endoscopy. A pathologist blinded to the OCT results reviewed each pathology specimen and determined the presence of the following histopathology: gastric cardia, squamous mucosa, pancreatic metaplasia, and intestinal metaplasia. An algorithm for diagnosing specialized intestinal metaplasia (SIM) was created by reviewing a training set of 40 biopsy-correlated OCT images. Two blinded investigators prospectively tested the algorithm on a validation set of 123 images.

RESULTS:

OCT images of squamous mucosa were characterized by a layered appearance without epithelial glands; gastric cardia, by vertical pit and gland structure, a well-defined epithelial surface reflectivity, and relatively poor image penetration; and SIM by an irregular architecture and good image penetration. The OCT criteria were 85% sensitive and 95% specific for SIM when applied retrospectively to the training set. When applied to the validation set, the algorithm was 81% sensitive for both OCT readers and 66% and 57% specific for diagnosing SIM. The interobserver agreement was good (kappa = 0.53).

CONCLUSIONS:

OCT imaging can identify SIM at the SCJ with an accuracy similar to that of endoscopy.

PMID:
17137858
PMCID:
PMC2719434
DOI:
10.1016/j.gie.2006.04.027
[Indexed for MEDLINE]
Free PMC Article
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