Clinical and morphological diagnostics of metaplastic and neoplastic changes in Barrett's esophagus
ARTICLE PDF (Українська)

Keywords

Barrett's esophagus, metaplasia, dysplasia, proliferative activity marker Ki-67

How to Cite

Kuryk, O. G., Yakovenko, V. O., Kolomoyets, M. Y., Tereshchenko, T. V., & Tkachenko, R. P. (2018). Clinical and morphological diagnostics of metaplastic and neoplastic changes in Barrett’s esophagus. Clinical and Preventive Medicine, (1), 25-32. https://doi.org/10.31612/2616-4868.1-4.2018.04

Abstract

Aim –analysis of the effectiveness of the morphological diagnosis with determination of metaplastic, neoplastic changes and proliferative activity of epithelium in Barrett's esophagus (BE).

Materials and methods. The analysis of diagnosis of BE cases based on the results of the screening endoscopic study with biopsy and morphological verification for 2014-2016 in the Medical Center " Oberig clinic", Kyiv. It was determined immunohistochemically the expression of proliferative activity marker Ki-67 (DAKO, SP6) in 20 cases with specialized intestinal metaplasia, 10 cases with dysplasia and 15 cases with gastric metaplasia. Staining for Ki67 was scored as positive if there was aberrant nuclear staining of columnar epithelium in surface epithelium. To evaluate the expression of Ki-67, determined the ratio of immunopositive nuclei to total nuclei in the samplein percent.

Results and discussion. The BE was diagnosed in 841 (36.8%) cases (95% confidence interval (CI) 36.02-39.76) from 2405 cases screening endoscopy (100%). Histologically - cardiac metaplasia was detected in 48 (5.71%) patients with 841, fundal metaplasia - in 136 (16.19%) cases; specialized intestinal metaplasia - in 625 (72,28%) and mixed metaplasia - in 32 (3.80%) patients. In 32 (3.81%) cases, a diagnosis of high and low dysplasia was detected (95% CI 2.04-4.62). In 24 out of 32 (75.0%) patients, low grade dysplasia was diagnosed, and in 8 (25.0%) - dysplasia of high degree. Adenocarcinoma was found in 4 (0.47%) patients (95% CI 0.20-1.36).

The immunohistochemical determination of proliferative activity marker Ki-67 in mucosa in Barret’s esophagus was studied. In mucosa with gastric metaplasia the percentage of cells expressing was 16,85±2,6%; in mucosa with specialized intestine metaplasia - 27,96±3,8% (p<0,05), and in mucosa with dysplasia - 42,84±6,2% (p<0,05),.

Conclusions . Morphological conclusion is the main objective criterion for the verification of the BE, which is important in choosing treatment tactics and a certain value in determining the prognosis of the disease. Increased proliferative activity ( the high Ki-67 expression) of the epithelium in the areas of intestinal metaplasia compared with areas of gastric metaplasia and significant increase in proliferative activity when dysplasia indicates the increase of the risk of occurrence of cancer in epithelium of BE.

https://doi.org/10.31612/2616-4868.1-4.2018.04
ARTICLE PDF (Українська)

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