Imaging of subsquamous Barrett's epithelium with ultrahigh-resolution optical coherence tomography: a histologic correlation study

Background

Optical coherence tomography (OCT) is being developed as a potentially valuable method for high-resolution cross-sectional imaging of the esophageal mucosal and submucosal layers. One potential application of OCT imaging is to identify subsquamous Barrett's epithelium in patients who have undergone ablative therapy, which is not visible on standard endoscopic examination. However, histologic correlation confirming the ability of OCT to image subsquamous Barrett's epithelium has yet to be performed.

Design

Histologic correlation study.

Objective

To perform histologic correlation of ultrahigh-resolution optical coherence tomography (UHR-OCT) imaging for identification of subsquamous Barrett's epithelium.

Setting

Academic Medical Center (University of Washington, Seattle, WA).

Patients

Fourteen patients with pathologic biopsy specimens, proven to be high-grade dysplasia or adenocarcinoma underwent esophagectomy.

Interventions

UHR-OCT imaging was performed on ex vivo esophagectomy specimens immediately after resection.

Main Outcome Measurements

Correlation of UHR-OCT images with histologic images.

Results

Subsquamous Barrett's epithelium was clearly identified by using UHR-OCT images and was confirmed by corresponding histology.

Limitations

Difficulty distinguishing some subsquamous Barrett's glands from blood vessels in ex vivo tissue (because of the lack of blood flow) in some cases. Imaging was performed with a bench-top system.

Conclusions

Results from this study demonstrate that UHR-OCT imaging is capable of identifying subsquamous Barrett's epithelium.

Abbreviations: OCT, optical coherence tomography, UHR-OCT, ultrahigh-resolution optical coherence tomography, BE, Barrett's esophagus, PDT, photodynamic therapy, HGD, high-grade dysplasia