Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: The presence of intestinal type goblet cells (ITGC) is essential for the diagnosis of Barrett's metaplasia (BM). However, we have seen cases diagnosed as BM based solely on the presence of columnar cells that: (a) resemble ITGC, or (b) that show positive staining with Alcian blue (AB). The clinical significance of goblet cell mimickers (GCM) is unknown. The aim of this study is to determine: (1) the prevalence of GCM in esophageal biopsies; (2) their association with ITGC; and (3) whether GCM or positive staining with Alcian blue is associated with a significant risk for malignant progression.
Methods: Initial biopsies from 78 patients with a mean follow-up of 72 months and with original diagnosis of BM negative for dysplasia were reviewed and re-classified into 3 categories: (1) ITGC, (2) GCM, or (3) “gastric” if they lacked ITGC and GCM. Additional sections of cases with available tissue were stained with AB at pH 2.5. Statistical analysis was performed using the Kaplan-Meier method and the log rank test for statistical significance.
Results: GCM were present in 35 cases, and were associated with ITGC in the same biopsy in 23 (66%) of these cases. ITGC were present in 56 cases, and the remaining 10 were “gastric.” Only the presence of ITGC was associated with significant risk for dysplasia (p = 0.0084). Positive Alcian blue staining was not associated with a significant risk for dysplasia.
Conclusions: The diagnosis of BM should be rendered only when ITGC are identified on routine H&E-stained sections.