Background and Aims

Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is used as an adjunct to forceps biopsy sampling in Barrett’s esophagus (BE). BE-associated crypt dysplasia (CD), which can be detected by WATS3D, involves crypts but not surface epithelium. The risk of neoplastic progression of CD has never been evaluated. The prognosis of WATS3D-diagnosed nondysplastic BE (NDBE) and low-grade dysplasia (LGD) is also unknown. We assessed the risk of progression of WATS3D-reported NDBE, CD, and LGD with high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC).

Methods

We analyzed patients who underwent WATS3D in routine care. Eligible patients had 2 WATS3D ≥12 months apart. Patients were categorized by the initial WATS3D finding as NDBE, CD, or LGD. Patient-years of observation were calculated by multiplying the mean follow-up by the number of patients. Progression, defined as a subsequent finding of HGD/EAC on forceps biopsy sampling, was assessed. The crude progression rate was calculated, and Kaplan-Meier analysis compared progression rates stratified by baseline histology. Bivariate analysis identified progression risk factors.

Results

Of 151,224 WATS3D cases, 43,145 (29%) had BE. Of these, 4545 patients had 2 WATS3D separated by ≥12 months. The mean follow-up was 1.97 years (range, 1.0-6.42). In patients with baseline NDBE, progression was .08% per patient-year (95% confidence interval [CI], .02%-.14%). Progression of baseline CD was significantly higher, at 1.42% per patient-year (95% CI, 0%-3.01%). For baseline LGD, progression was 5.79% per patient-year (95% CI, 1.02%-10.55%). Other risk factors for progression were increasing age and BE segment length.

Conclusions

NDBE found on WATS3D has a very low risk of progression. CD reported on WATS3D appears to be a neoplastic precursor lesion, with a risk of progression in this study significantly higher than NDBE but lower than LGD. The clinical utility of CD requires further investigation.

中文翻译：

---

Barrett 食管、隐窝发育不良和低度不典型增生通过 3 维计算机辅助分析的广域经上皮取样诊断的进展：回顾性分析

背景和目标

具有 3 维计算机辅助分析 (WATS3D) 的广域跨上皮取样被用作巴雷特食管 (BE) 中镊子活检取样的辅助手段。可以通过 WATS3D 检测到的 BE 相关隐窝发育不良 (CD) 涉及隐窝，但不涉及表面上皮。从未评估过 CD 肿瘤进展的风险。WATS3D 诊断的非发育异常 BE (NDBE) 和低度不典型增生 (LGD) 的预后也是未知的。我们评估了 WATS3D 报告的 NDBE、CD 和 LGD 与高度不典型增生 (HGD) 或食管腺癌 (EAC) 的进展风险。

方法

我们分析了在常规护理中接受 WATS3D 的患者。符合条件的患者有 2 次 WATS3D ≥12 个月。根据最初的 WATS3D 发现将患者分类为 NDBE、CD 或 LGD。通过将平均随访时间乘以患者人数来计算患者的观察年数。评估进展，定义为随后在镊子活检取样上发现 HGD/EAC。计算了粗进展率，Kaplan-Meier 分析比较了按基线组织学分层的进展率。双变量分析确定了进展风险因素。

结果

在 151,224 例 WATS3D 病例中，43,145 例（29%）患有 BE。其中，4545 名患者有 2 次 WATS3D，间隔≥12 个月。平均随访时间为 1.97 年（范围 1.0-6.42）。在基线 NDBE 患者中，进展率为每患者年 0.08%（95% 置信区间 [CI]，0.02%-.14%）。基线 CD 的进展显着更高，为每患者年 1.42%（95% CI，0%-3.01%）。对于基线 LGD，进展率为 5.79%/患者年（95% CI，1.02%-10.55%）。进展的其他风险因素是年龄增加和 BE 段长度。

结论

在 WATS3D 上发现的 NDBE 的进展风险非常低。WATS3D 报告的 CD 似乎是一种肿瘤前体病变，在本研究中进展风险显着高于 NDBE 但低于 LGD。CD 的临床应用需要进一步研究。