Sirieix, P.S.; O'Donovan, M.; Brown, J.; Coleman, N.; Fitzgerald, R.C.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA46
Academic Journal
Introduction: Oesophageal adenocarcinoma incidence is increasing rapidly. Endoscopic screening for the population at risk is not feasible and surveillance of patients with known Barrett's oesophagus (BE) is prone to sampling bias and the subjective interpretation of dysplasia. Aims: To determine whether a novel marker of cell cycle entry, mini-chromosome maintenance (MCM) protein predicted cancer risk and whether this could be used in combination with a surface sampling method. Methods: Archival specimens (30 squamous oesophagus (SE), 62 BE +/- dysplasia, 16 adenocarcinoma (AC)) were stained for Mcm2. In addition, 9 patients with 3-13 years follow up who developed AC were compared with 18 controls matched for age and length of follow up who did not progress. Endoscopic cytological brushings were taken from a prospective cohort (61 SE, 90 BE +/- dysplasia and 11 AC) and scored blind as Mcm2 positive or negative. Results: Correlation between Mcm2 surface expression and dysplasia (p<0.05 for biopsies and brushings). Since ∼40% of non-dysplastic BE samples were Mcm2 positive we tested whether surface expression predicted progression. 13/14 (93%) cancer patient biopsies, prior to any dysplasia diagnosis, were Mcm2 positive on the surface compared with 13/67 (19%) biopsies from matched controls. Conclusion: Surface expression of Mcm2 can be used to detect the population at risk of developing high grade dysplasia and AC. A combined brushing technique with Mcm staining has the potential to be exploited as a non-endoscopic screening test.


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