Lovat LB et al. (2006) Elastic scattering spectroscopy accurately detects high grade dysplasia and cancer in Barrett's oesophagus. Gut 55: 1078–1083

Endoscopic surveillance of Barrett's esophagus is time-consuming, yields low detection rates, and is hampered by poor agreement between pathologists. Now, a UK team has shown that a relatively inexpensive imaging technique—elastic scattering spectroscopy (ESS)—could reduce the need for pathologists to review low-risk biopsies by 60%, without a marked loss of accuracy, and could, therefore, provide substantial savings of time and money.

Overall, the team examined 181 biopsy sites (from 81 patients), for which pathologists had agreed on the histologic diagnosis; 595 spectra were generated from these sites. 'Leave one out' cross-validation (where all data points are used to train the algorithm, except one, which is then tested) revealed that ESS showed 92% sensitivity and 60% specificity when differentiating between low-risk (normal or low-grade dysplasia) and high-risk (cancer or high-grade dysplasia) sites, and a sensitivity and specificity of 79% when discriminating cancer or high-grade dysplasia from inflammation. Furthermore, a negative ESS result (i.e. exclusion of high-grade dysplasia or cancer) had an accuracy of over 99.5%.

The authors highlight the need to test their ESS algorithm in prospective studies. They also speculate that combining ESS with other optical, biopsy-driven approaches will be more effective than ESS alone in reducing the number of conventional biopsies required for surveillance of Barrett's esophagus, and might, eventually, obviate the need for conventional biopsies.