A predominance of sulfated
mucin in the nongoblet columnar cells of Barrett's specialized metaplastic epithelium has been postulated to be a form of mild dysplasia and to indicate an increased risk of
adenocarcinoma. Flow cytometry for the analysis of nuclear
DNA content and cell cycle parameters has also been postulated to be an objective aid in the diagnosis of dysplasia and
carcinoma in
Barrett's esophagus. The authors investigated the relationship among sulfated
mucin, flow cytometric data, and histologic diagnosis in each of 152 biopsies from 42 patients who had Barrett's specialized metaplastic epithelium. Sulfated
mucin, as detected by the
high iron diamine-Alcian blue stain, was present in biopsies from 8 of 11 (73%) patients with the histologic diagnosis of dysplasia or
carcinoma, in 7 of 9 (78%) patients whose biopsies were indefinite for dysplasia, and in 12 of 22 (55%) patients whose biopsies were negative for dysplasia (P = 0.37). Sulfated
mucins predominated in 9%, 22%, and 9% of the patients, respectively (P = 0.56). Abnormal flow cytometry (
aneuploidy or increased G2/
tetraploid fraction) was found in all patients with the histologic diagnosis of dysplasia or
carcinoma, in 3 of 9 (33%) indefinite for dysplasia, and in 1 of 22 (5%) negative for dysplasia (P = less than 0.0001). Neither the presence nor the predominance of sulfated
mucin in the specialized metaplastic epithelium of
Barrett's esophagus has sufficiently high sensitivity or specificity for dysplasia or
carcinoma to be of value in managing patients. Abnormal flow cytometry shows excellent correlation with the histologic diagnosis of dysplasia and
carcinoma; it detects a subset of patients whose biopsies are histologically indefinite or negative for dysplasia, but who have flow cytometric abnormalities similar to those otherwise seen only in dysplasia and
carcinoma.