Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.

BACKGROUND: The diagnostic advantage of methylene blue (MB) chromoendoscopy in Barrett's esophagus is unclear. METHODS: Patients with columnar-lined esophagus (CLE) were enrolled into a prospective, randomized crossover trial of MB-directed biopsy versus conventional biopsy. RESULTS: Forty-seven patients (19 long-segment CLE; 28 short-segment CLE) were enrolled and underwent MB-directed biopsy. Sensitivity and specificity of MB for specialized intestinal metaplasia were 53% and 51%, respectively. Sensitivity and specificity of MB for dysplasia were 51% and 48%, respectively. Thirty-five patients (15 long-segment CLE; 20 short-segment CLE) completed the crossover trial. Relative frequencies for specialized intestinal metaplasia were 73% and 71% from MB-directed and conventional biopsy specimens, respectively (p = 0.73). Relative frequencies for dysplasia were 20% and 18% from MB-directed and conventional biopsy specimens, respectively (p = 0.65). In patients with long-segment CLE, dysplasia was diagnosed in 10 patients with MB and 7 patients with conventional biopsy methods (p = 0.25). The number of biopsy specimens per EGD was greater with MB, which may have influenced the diagnosis. Histologically, the grade of dysplasia was indefinite/low in nearly all of the dysplastic specimens. CONCLUSIONS: Results of MB-directed biopsy were similar to conventional biopsy in detecting specialized intestinal metaplasia and indefinite/low-grade dysplasia. MB was not useful in short-segment Barrett's esophagus.

Relationship between the size and margin status of ductal carcinoma in situ of the breast and residual disease.

BACKGROUND: For women with ductal carcinoma in situ (DCIS) of the breast who have been treated with breastconserving surgery, the usefulness of size and surgical margin status (i.e., presence or absence of disease at the point of excision) as prognostic factors for predicting residual disease has not been well established. This study was conducted to determine more clearly the relationship between size and margin status of mammary DCIS to residual disease. METHODS: The pathology records of 232 consecutive patients with mammary DCIS who had been initially treated with lumpectomy at the University Hospitals of Cleveland were retrospectively reviewed. The size of the DCIS and the surgical margins of lumpectomy were analyzed. Residual disease was defined as the persistence of DCIS in the re-excision and/or mastectomy specimens. RESULTS: Residual disease was found in 15 of 101 patients with DCIS of less than 1.0 cm in longest dimension, in 27 of 96 patients with DCIS of 1.0-2.4 cm in size, and in 24 of 35 patients with DCIS of greater than or equal to 2.5 cm in size (P<.001). Residual disease was found in 30 of 77 patients with DCIS and positive margins, in 11 of 59 patients with DCIS and close margins (< or =1mm), and in 10 of 73 patients with DCIS and negative margins (>1 mm) (P =.001). In multivariate analysis, the occurrence of residual disease was associated with large tumor size (i.e., > or =2.5 cm) (odds ratio [OR] = 7.7; 95% confidence interval [CI] = 3.13-20.00; two-sided P = .0001) and with positive margin status (OR = 2.2; 95% CI = 1.02-4.55; two-sided P = .04). CONCLUSIONS: The size and margin status of DCIS each were found to be independent predictors of residual disease.