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PLoS Med. 2015 Jan 29;12(1):e1001780. doi: 10.1371/journal.pmed.1001780. eCollection 2015 Jan.

Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett's esophagus: a multi-center case-control study.

Author information

1
MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, United Kingdom.
2
Department of Histopathology, Addenbrooke's Hospital, Cambridge, United Kingdom.
3
University College London Hospital, London, United Kingdom.
4
Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
5
Nottingham Queen's Medical Centre, Nottingham, United Kingdom.
6
Cancer Prevention Trials Unit, London, United Kingdom.
7
Queen Alexandra Hospital, Portsmouth, United Kingdom.
8
St Mark's Hospital, London, United Kingdom.
9
East and North Hertfordshire NHS Trust-QEII and Lister Hospitals, Welwyn Garden City and Stevenage, United Kingdom.
10
Northern Region Endoscopy Group, United Kingdom; North Tyneside General Hospital, North Shields, United Kingdom.
11
Northern Region Endoscopy Group, United Kingdom; County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom.
12
Northern Region Endoscopy Group, United Kingdom; South Tyneside NHS Foundation Trust, South Shields, United Kingdom.
13
Northern Region Endoscopy Group, United Kingdom; North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom.

Abstract

BACKGROUND:

Barrett's esophagus (BE) is a commonly undiagnosed condition that predisposes to esophageal adenocarcinoma. Routine endoscopic screening for BE is not recommended because of the burden this would impose on the health care system. The objective of this study was to determine whether a novel approach using a minimally invasive cell sampling device, the Cytosponge, coupled with immunohistochemical staining for the biomarker Trefoil Factor 3 (TFF3), could be used to identify patients who warrant endoscopy to diagnose BE.

METHODS AND FINDINGS:

A case-control study was performed across 11 UK hospitals between July 2011 and December 2013. In total, 1,110 individuals comprising 463 controls with dyspepsia and reflux symptoms and 647 BE cases swallowed a Cytosponge prior to endoscopy. The primary outcome measures were to evaluate the safety, acceptability, and accuracy of the Cytosponge-TFF3 test compared with endoscopy and biopsy. In all, 1,042 (93.9%) patients successfully swallowed the Cytosponge, and no serious adverse events were attributed to the device. The Cytosponge was rated favorably, using a visual analogue scale, compared with endoscopy (p < 0.001), and patients who were not sedated for endoscopy were more likely to rate the Cytosponge higher than endoscopy (Mann-Whitney test, p < 0.001). The overall sensitivity of the test was 79.9% (95% CI 76.4%-83.0%), increasing to 87.2% (95% CI 83.0%-90.6%) for patients with ≥3 cm of circumferential BE, known to confer a higher cancer risk. The sensitivity increased to 89.7% (95% CI 82.3%-94.8%) in 107 patients who swallowed the device twice during the study course. There was no loss of sensitivity in patients with dysplasia. The specificity for diagnosing BE was 92.4% (95% CI 89.5%-94.7%). The case-control design of the study means that the results are not generalizable to a primary care population. Another limitation is that the acceptability data were limited to a single measure.

CONCLUSIONS:

The Cytosponge-TFF3 test is safe and acceptable, and has accuracy comparable to other screening tests. This test may be a simple and inexpensive approach to identify patients with reflux symptoms who warrant endoscopy to diagnose BE.

PMID:
25634542
PMCID:
PMC4310596
DOI:
10.1371/journal.pmed.1001780
[Indexed for MEDLINE]
Free PMC Article

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