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Vol. 5, 405-406. Ma /996 Cancer Epidemiology, Biomarkers & Prevention 405

Short Communication

Reproducibility of an Esophageal Biopsy Sampling Procedure in a High- Incidence Area for Esophageal Cancer in Northern China’

Li Dong Wang,2 Qi Zhou, Rei Yiong Guo, Ying Xing, bility of the biopsy sampling procedure. In the present study, Bao Cai Zhang, Qi Ju Li, and Chung S. Yang2 we examined serial biopsy specimens obtained over a short

Laboratory for Cancer Research, Henan Medical University. Zhengzhau time interval to study the reproducibility of the biopsy sampling IL. D. W., Q. Z.l; Nanyang Medical School, Nanyang IR. Y. G.l, Xinxiang procedure. The information obtained from the present study Medical College. Xinxiang Central Hospital. Xinxiang [Y. X.. B. C. Z.. Q. J. LI, should be useful for the design of new intervention trials and for Henan. China: and Laboratory for Cancer Research, College of Pharmacy, Rutgers the evaluation of previous follow-up studies on early esopha- University. Piscataway. New Jersey 08855 IL. D. W.. Q. Z., C. S. Y.I geal lesions.

Abstract Materials and Methods The objective of this study was to evaluate the Twenty-five individuals (15 males and 10 females, ages 20 to reproducibility of the biopsy sampling procedure in 60 years) from a high-incidence area for EC in Xinye County research on esophageal lesions. Biopsies were taken from of Henan Province, China, were recruited for the endoscopic the middle and lower thirds of the esophagus, one from biopsy examinations. Esophageal mucosa biopsies were taken each site, from 25 subjects in a high-incidence area for at each endoscopic examination, one each from the middle third esophageal cancer in Xinye County of Henan Province, (30-32 cm from incisor teeth) and the lower third (2-3 cm China. The biopsy sampling procedure was repeated on above the gastroesophageal junction) of the esophagus. The the same subjects 10 days later. When the biopsies were sampling procedure was repeated on the same 25 subjects 10 analyzed together and those with worse pathologies were days later. During this study, all subjects were asked to follow used for diagnosis, 52% of the subjects had the same their regular dietary habits and were not given any medication. grade of lesions in the second biopsy examination, 32% All of the biopsies were fixed immediately with 80% alcohol had lower-grade lesions, and 16% had higher-grade and embedded with paraffin. Serial sections at S j.m were made lesions. and stained with H&E for histopathological analysis. These slides were coded and evaluated by one pathologist, and the Introduction code was broken after all of the histopathological analyses were completed. Histopathological diagnoses and evaluations were Esophageal biopsy has been widely used in the detection and made according to the cellular morphological changes and characterization of precancerous and early cancerous lesions in tissue architecture using previously established criteria (6). In high-incidence areas of EC3 (1-3). The relative ease of repeat brief, the epithelium was graded as “normal,” “BCH,” or endoscopy has made it possible to determine the natural history “Dys.” Normal epithelium was characterized by nonkeratinized of EC and to monitor the clinical course of lesions. Serial stratified squamous epithelium with 1-3 basal cell layers; pa- biopsies at different time points have also been used in inter- pillae were usually confined to the lower half of the epithelium. vention studies to monitor the reversion or progression of the In BCH, the number of proliferating basal cells was increased lesions (I , 4-10). In our recent randomized double-blind inter- to more than 3 cell layers. On the basis of the expansion of the vention study on the effect of calcium supplementation on early proliferating basal cells within the epithelium, BCH was di- esophageal lesions, a large number of subjects diagnosed with vided into BCH I, with 3-5 layers of proliferating basal cells lesions in the initial biopsy examination had normal epithelia in that usually occupied the lower third of the esophageal epithe- the second examination after an intervention period of I year hum; BCH II, with more than S proliferating basal cell layers both in the calcium treatment group (44%) and in the placebo in the lower half of the epithelium; and BCH III, in which group (35%; Ref. 6). One possible explanation for this observed hyperproliferative basal cells accounted for more than half of difference between the two biopsy examinations is the varia- the epithelial thickness. Dys was characterized by the partial loss of cell polarity and the presence of nuclear atypia.

Received 7/19/95; revised 1/31/96; accepted 1/31/96. Results and Discussion The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked aduertisement in In the first biopsy examination, the number of subjects in the accordance with 18 U.S.C. Section 1734 solely to indicate this fact. categories of normal, BCH I, BCH II, and BCH III & Dys were I Supported by the Chinese National Natural Science Foundation and by United 5, 10, 5, and 5, respectively, based on the examination of States National Institute of Environmental Health Science Center Grant ES middle-third biopsies; the numbers were 3, 5, 10, and 7, re- 05022. spectively, based on the lower-third biopsies. In the second 2 In the United States. address requests for reprints to C. S. Y. at Laboratory for Cancer Research, College of Pharmacy. Rutgers University. Piscataway, NJ biopsy examination, the respective numbers were 2, 16, 3. and 08854. Phone: (908) 445-5360; Fax: (908) 445-0687. In China, address requests 4 based on the middle-third biopsies and 4, 1 1 , S. and 4 based for reprints to L. D. W. at Laboratory far Cancer Research, Henan Medical on lower-third biopsies. Consistent with previous reports (10- University. 40 Da Xue Road. Zhengzhau Henan. 450052 China

‘ The abbreviations used are: EC, esophageal cancer: BCH. basal cell hyperplasia; I 5), multicentric lesions of the esophagus were frequently ob- Dys. dysplasia. served. BCH III and Dys were found in both the middle-third

Table I Reprodu cibility of the biopsy procedure for the middl c-third and epithelium surface with a substance such as Lugol’s iodine (21) Iower-third segments of the esophagus” may increase the reproducibility of the biopsy procedure.

With With lower- higher- Acknowledgments Unchanged grade grade lesions The authors thank Drs. Li Mi He and Dao Xiu Zhou (Nanyang Hospital, Nanyang. lesions Henan Province, China) for their help in organizing this study.

a ‘7e fl % ,i % References Middle third I 2 48 6 24 7 28 Lower third” 8 32 12 48 4 16 I. Qiu, S. L., and Yang. G. R. Precursor lesions of esophageal cancer in high-risk Overall’ 13 52 8 32 4 16 populations in Henan Province, China. Cancer (Phila.), 62: 551-557, 1988. 2. Goldman, H., and Antonioli, D. A. Mucosal biopsy of the esophagus, stomach, “ The results from the second biopsy examination were compared with those of and proximal duodenum. Hum. Pathal., 13: 423-448, 1982. the first examination. The lesions were considered unchanged unless they were at 3. Munoz, N., Crespi. M., Grassi, A., Wang, G. Q., Shen, Q., and Li, Z. C. least two grades lower or higher in the second examination (e.g. , from BCH II to Precursor lesions of ocsaphageal cancer in high-risk populations in Iran and normal). China. Lancet, 1: 876-879, 1982. I, In one sample. an accurate diagnosis was nat made. 4. Robertson. C. S., Mayberry, J. F., Nicholson, D. A., James, P. 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There were no differences in mean China. Cancer Epidemiol., Biomarkers & Prey., 2: 71-78, 1993. epithelial thickness (range, 0.3-0.4 mm) between the normal 7. Munoz, N., Wahrendorf, J., Lu, J. B., Crespi, M., Thumham, D. I., Day, N. E.. epithelia and epithelia with lesions. The result is in agreement Zheng, H. J., Grassi, A., Li, ‘A’. Y., Liu, G. L., Lang, Y. Q., Zhang. C. Y., Zheng. with previous reports (16-18). S. F.. Li. J. Y.. Correa, P., O’Conor, G. T.. and Bosch, X. No effect of riboflavin, Evaluation of histopathological changes in individual sub- retinal, and zinc on prevalence of precancerous lesions of aesophagus: randomized double-blind intervention study in high-risk population of China. Lancet, 1: jects (Table 1 ) showed differences between the two examina- 111-114, 1985. tions. For example, in the second biopsy examination, 24 and 8. El-Guneid, A.. El-Sherif, A. M., Murray-Lyon. I. M., Zureikat. N.. and 48% of the subjects had lower-grade lesions (by 2 grades) than Shousha, S. Effect of chewing Qat an mucosal histology and prevalence of the first biopsy examination in the middle-third and lower-third Helicobacter pylon in the aesaphagus, stomach and duodenum of Yemini pa- biopsies, respectively (P < 0.05, test). When the middle- tients. Histopathology, 19: 437-443, 1991. third and lower-third biopsies were analyzed together, and the 9. Jarvis, L., Dent, J., and Whitehead, R. Morphometric assessment of reflux oesophagitis in fibreoptic biopsy specimens. J. Clin. Pathol., 38: 44-48, 1985. biopsies with worse pathologies were used for diagnosis, 52% 10. Reid, B. J., Weinstein. W. M., Lewin, K. j., Haggitt, R. C., Vandeventer, G., of the subjects had the same grade of lesions in the second Denbesten, L., and Rubin, C. E. Endoscopic biopsy can detect high-grade dys- biopsy examination, 32% had lower-grade lesions, and 16% pla.sia or early adenocarcinoma in Barrette’s esophagus without grossly recog- had higher-grade lesions. Of the 1 2 subjects identified with nizable neaplastic lesions. Gastroenterology, 94: 81-90, 1988. BCH HI & Dys lesions in the first biopsy examination, 6 I I. Monnier, P., Savary, M., Pasche. R., and Anani. P. Intraepithelial carcinoma remained in the same categories, but the other 6 had less severe of the aesophagus: endoscopic morphology. Endoscopy. 13: 185-191, 1981. lesions (by 2 grades) in the second biopsy examination. How- 12. Macta, M., Koga, S., Shimizu, N., lnoue, Y., Ishiguro, M.. and Sawada, T. Carcinogenic potential of the nan-cancerous epithelium in patients with oesoph- ever, 8 subjects previously identified with lower-grade lesions ageal cancer. Br. J. Surg., 75: 531-532, 1988. were found to have BCH III & Dys in the second biopsy 13. Jaskiewicz. K.. Banach. 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Downloaded from cebp.aacrjournals.org on September 30, 2021. © 1996 American Association for Cancer Research. Reproducibility of an esophageal biopsy sampling procedure in a high-incidence area for esophageal cancer in northern China.

L D Wang, Q Zhou, R Y Gou, et al.

Cancer Epidemiol Biomarkers Prev 1996;5:405-406.

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